Health Net™: Improving the Primary Source Verification Process

As a result of its acquisition by Centene, Health Net needed to credential a 27% larger network with new types of providers. Health Net also had to meet Centene’s accelerated timelines for onboarding providers. Given the volume and the size of its staff, credentialing more providers in a shorter timeframe would not be achievable without additional resources.

The credentialing department was looking for a new way to manage the increased file volume and shorter deadlines. Health Net started exploring working with a CVO, but had concerns about the timeliness, data integrity, lack of responsiveness and unknown costs of working with a new partner.

Ultimately, Health Net chose CAQH as their Primary Source Verification CVO since their experience working with CAQH for Credentialing had been a positive one. CAQH provided highly trained staff and technology automation to help Health Net manage the larger file volumes while increasing the speed and quality of the process.

The Results

After implementing CAQH PSV, the credentialing team increased its file volume by one-third and improved overall quality by five percent. Without CAQH, Health Net estimated it would have needed to hire six to eight additional staff to achieve similar results.

20 %

reduction

in labor costs

12 Day

decrease

in the number of days required to complete PSV activities

5 %

improvement

in overall data quality

Optimized operational efficiencies

Health Net has reached Centene’s goal for credentialing, re-credentialing and PSV processing and now has the resources to scale for additional growth.

Accelerated PSV completion times

In CAQH, provider data is verified with more than 500 sources every time a provider updates their credentialing information. This real-time data verification and automated workflow has helped Health Net achieve a 12-day reduction to complete PSV files.

Improved data quality

Data in CAQH is entered by providers themselves, verified with authoritative and primary sources and validated using advanced data science. This multi-step process improved Health Net’s data quality 5%.

Reduced audit vulnerability

The 35-element manual verification process Health Net was using was replaced with the CAQH automated, NCQA-compliant checklist that meets all state and federal requirements.

Automated staff workflow

The Health Net team now focuses on files with “irregular results,” and data that is “deficient after provider outreach”. This has reduced Health Net’s labor costs 20% and eliminated the need to hire additional staff.

Eliminated pass-through fees

Health Net eliminated provider fees and pass through costs with an automated, direct connection from most primary sources directly to the CAQH PSV solution.

CASE STUDY