Maintaining High Quality Credentialing Amid The Great Resignation

As a result of COVID-19, and the strain the pandemic has put on healthcare providers, unprecedented numbers of clinicians are leaving their practices–or healthcare altogether.

For health plans, this high level of turnover could have significant consequences for the size and quality of their provider network–as well as their ability to maintain an accurate provider directory.

WIDESPREAD  PHYSICIAN TURNOVER

In a recent survey, physicians expressed concern about increased paperwork and administrative burdens interfering with their ability to treat patients or spend time away from work. Unfortunately, this is not a new issue. And while the industry is making progress in this arena–for example, by adopting more electronic processes to manage common administrative transactions–there is still much work to be done.

In the last two years, the time and financial constraints brought on by inefficient administrative processes have been further compounded by unprecedented patient loads during COVID-19. This has required many physicians to work long, and unpredictable hours while managing their regular responsibilities.

As a result of these factors, in the last year, 46% of physicians considered leaving their current workplace to look for a new healthcare employer, and 43% considered early retirement.

For health plans, maintaining their network could require fast, wide-scale recruitment and onboarding of new providers. However, this cannot come at the expense of accurate credentialing and regulatory considerations, appropriate allocation of financial resources, or member satisfaction.

A STREAMLINED SOLUTION

Developed in partnership with member health plans, VeriFideTM from CAQH consolidates and standardizes the primary source verification (PSV) process.

Seamlessly integrated with CAQH ProView, VeriFide leverages self reported data from 1.9 million providers who regularly attest to their professional and practice information. It also affords health plans greater accuracy, speed and control over their PSV processes through:

  • Automation with most primary data sources. VeriFide deploys advanced automated technologies that compare each provider’s information against primary data sources for accuracy. By eliminating manual processes, it takes less time to work on a provider file, and also reduces the likelihood of human error. 
     
  • Standardization of data elements for quicker credentialing. Each health plan participating in VeriFide agrees to limit the verified data elements to the standard set of 14 required by NCQA. This is the information deemed essential for the credentialing process.
     
  • Industry-wide alignment of provider credentialing dates. NCQA requires health plans to re-credential providers at least once every three years. This process is conducted in different months by different plans, creating duplication for providers contracting with multiple health plans. To reduce this inefficiency and duplication process, over time VeriFide will align credentialing dates for providers, so that each will have a dedicated re-credentialing date across all health plans.
     
  • Categorized results for quicker credentialing. Each verified data element in the provider file is categorized by VeriFide, based on the results of the verification; for example, A is valid and current, B is potentially irregular and C is very irregular. This enables each health plan to immediately and automatically route the files needing special follow-up to their appropriate departments, reducing delays.

And VeriFide returns 95% of initial provider files within 8 -14 days, with 98.5% accuracy and completeness–saving critical time when managing a high volume of providers. 

To learn how VeriFide can help your organization improve its PSV process, contact PSV@CAQH.org.  

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