How to Evaluate Physician Credentialing Service Providers?

Credentialing services for physicians are a necessity for companies in the healthcare industry. The concept is of great importance as well as costly. Considering it is also a time-consuming process, companies wish to avail the services of an appropriate service provider. Providers that can minimize both time and cost for the organization. In order to make the best selection, they must take into account the various factors that may have an effect. This means that the company must carry out proper evaluations of the service providers present in the market. The factors they can consider while evaluating include:

The Amount of Time the Vendor Has Been Providing Services. 

It is important to make sure that there service providers acquired are legitimate. This can be confirmed through the help of references. This would allow you to feel more secure handing over the work to the vendor. Such security is important as there have been cases where a vendor has disappeared. This can turn into a problematic situation for the organization. Therefore, it is important for them to minimize the occurrence of such a situation. The company properly review the vendor they are entrusting with information. They can do this by asking difficult questions from them and checking their operations. A safe choice for the firm would be to consider a vendor that has been operating for at least five years. They can even look into the employees present at the service. If the number is above ten workers then it might be a safe option for them to pursue. By considering these factors, they can make sure that the acquired services will not cause them any damage by disappearing. 

Their Understanding of Fee Schedules and the Percentage to Be Expected From Major Payers.

A vendor must be asked about certain issues they will be dealing with for the healthcare company. These credentialing services for physicians are required to validate their knowledge to the organization. This would make collaboration easier as well as secure. It would also allow the vendor to be aware of the importance of reimbursements to the company. The practice is dependent upon the reimbursements therefore, they wish to have a vendor who understands this dependence. With such aspects cleared out, there would be smoother running of the operations. Thus, this would not only prove helpful for the service provider but also for the practice. This way the costs would also be controlled for the company as there would be no misunderstanding. Along with this, the expectations of the company would also be met without any further issues. This factor is of great importance for companies who wish to make the process an economical one for them. 

The Importance of Payers and the Negotiations Prior To Signing.

There are certain negotiations carried out before signing. The insurance contract is reviewed and discussed. This helps to make sure that both the partners are on the same page. It is critical for the process to take place as smoothly as possible. Payer agreements must also be negotiated and everything should be set in a manner that the company is satisfied. This would help to make sure that later on once the process begins, the service providers would know the priorities. This would also allow them to approach the whole credentialing process in a manner that is acceptable by the organization. This is an important factor because if the service provider refuses such negotiation, they might be illegitimate. Therefore, be sure to ask such questions as their denial can help you decide whether to trust them or not. In case they refuse, you’d know they are not the most secure choice to go with. After all, it is a sensitive matter and must be entrusted upon a reliable vendor. 

Their Method of Measuring Quality and Performance. 

In order to properly evaluate a professional credentialing organization, Key performance indicators (KPIs) are used. These KPIs are vital metrics that include:

  • Total Days in Enrollment
  • Application processing time
  • Enrollment denial percentage
  • Days in the signature stage

All these are of great importance to the organization. They help them to gain an accurate image of the overall performance. Such information can be used for the benefit of both the healthcare organization as well as the service provider. They would allow them to highlight where the performance is lacking and thus, work to improve it. Any flaws in the system would be corrected this way, resulting in the smoother running of operations. With a focus on this, the company would be able to decrease the time delays in the process. This would contribute to making it more economical as well. Hence, it can be said that KPIs being used by the service provider must be taken into account. 

The Technology Used To Increase Efficiency in the Enrollment Process.

Technology has helped in many fields including health. Therefore, whilst choosing the credentialing services for physicians, the technology used must be considered. Its presence would allow the company the comfort of knowing that human error is minimized. Reliance on simple excel spreadsheets and manual working is outdated now. It would cause problems in the process that can otherwise be avoided. Therefore, it is important to make sure that the vendor has the appropriate and updated equipment. This would prove helpful for the company in matters of money and time as well. With appropriate gadgets, the vendor can make sure to avoid any mistakes that may take place. This would contribute to the quickening of the process as time delays would be eliminated. Furthermore, with fewer mistakes and time delays, the investment would also decrease. Therefore, the company can then use this time and money for other important purposes. 

A company must therefore not be hasty while choosing their vendor considering the importance of credentialing. Through the help of these evaluating factors, a better decision can be reached. This would help it to carry on its operation without having to worry about the credentialing process.

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