Delegated credentialing can save time, money, and effort for health plans and provider groups. But it’s not for everyone. Providers need to fully understand what’s involved and assess their readiness to take on enhanced credentialing responsibilities. Here’s how.
Credentialing is a key part of the provider enrollment process with significant implications for patient safety, care quality, and the financial success of a payer-provider partnership.
However, credentialing can be time consuming and labor intensive, especially for health plans who may have tens of thousands of clinicians to validate on a regular basis. It can take months for a provider to receive approval to start working with a health plan – and every extra day of waiting to be credentialed equates to lost revenue for their practice.
To speed up the process…
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Innovation is no longer optional for established health payers and digital native startups. Without revamping inefficient processes, payers risk falling behind in the race for provider participating providers and market share.
Here are the first steps payers can take on the path toward sustainable, successful innovation.
The health plan marketplace is evolving quickly as changing demographics, new regulations, and cutting-edge technologies sweep away the status quo. Both commercial health plans and Medicare Advantage (MA) plans are seeing increased competition for visibility and market share, especially as consumers become more and more savvy about their preferences and needs.
But are internal health plan operations innovating at the same rate? Unfortunately for many payers, the answer is “no.”
Even as an emerging class of fresh-faced, digital-first payers and direct-to-consumer (DTC) telehealth companies rises up to challenge the notion of business as usual, a worrying number of payers are still relying on manual processes and fragmented workflows for network development and maintenance. As a result, they are missing out on key opportunities and creating frustration for internal stakeholders and their external partners.
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