Costly data acquisition fees, human data entry errors, manual processes, incomplete files and provider abrasion are a few reasons why Health Net explored opportunities to improve their credentialing and primary source verification process.
The credentialing department was considering the services of other credentials verification organizations (CVO) to manage the increased file volume. However, Health Net had concerns around their timeliness, data integrity, lack of responsiveness and unknown costs, and as a result the department decided to go in a different direction.
The health plan’s existing experience with other CAQH provider data solutions had been a positive one. They decided to work with the VeriFide team to address their need to handle the larger PSV file volume while increasing quality and speed.
As a result of its acquisition by Centene, Health Net needed to adopt their credentialing policies; this included an increase in the types of healthcare providers requiring credentialing. The scope of the Health Net provider network had increased in size by 27 percent and the adopted-time metrics for onboarding providers were reduced. Given the volume and the size of its staff, this was not achievable without additional assistance or resources.
After implementing VeriFide the credentialing team has increased its file volume by one-third and improved overall quality by 5 percent. Without utilizing the resources of VeriFide to meet the new demand, Health Net estimated it would need to hire between six and eight associates to manage the volume internally.
Without utilizing the resources of VeriFide to meet the new demand, Health Net estimated it would need to hire between six and eight associates to manage the volume internally.