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From the April 2004 Issue Keeping Data Storage Healthy: Case History Streamlined Support: Case History Gaining
Credence and Fast Payments With Software: |
Gaining Credence and Fast Payments With Software By Karin Lillis, Managing Editor A Midwest medical group eliminates redundant paperwork with a provider-credentialing program.
Manual provider credentials processing can create hours of data entry work and build mountains of paperwork. An Arkansas medical group learned that lesson quickly—and responded by implementing a credentialing software program that has helped staff save both time and money. Scaling Paper Mountains When Heimark joined Cooper Clinic five years ago, there was no credentialing software in place. When a new provider came on board, she had to manually complete as many as 13 different enrollment forms, get the provider’s signature and then mail the completed documents to each insurance carrier. She followed a similar process each time a staff provider’s license or credentialing information needed to be updated. The process amounted to hours of data entry work and piles of paper. Filling out forms by hand was not complicated, she says, but the process was redundant and left room for errors. "I knew there had to be a better way to do provider enrollment," Heimark says. About a year later, the medical group bought its first credentialing software. But she felt the headaches soon afterward. Within months, the software was obsolete, Heimark says. Vendor staff lacked medical background and failed to understand end-user needs. "The only thing that system did was warehouse information for us," Heimark says. "We still had to manually complete many provider forms for various insurance companies." Heimark needed to find a more efficient option—and fast. As a member of the human resources department, she could not dedicate the majority of her time to provider credentials. After considering several vendors, Cooper Clinic focused on Brentwood, Tenn.-based Sy.Med Development Inc. and its OneApp healthcare credentialing software. The software offered Cooper Clinic a user-friendly provider database, a one-click electronic application completion process, data tracking and reporting, and the ability to scan and store images of virtually any license, certificate or other paper document. It also gave Heimark the capability to electronically scan and update provider applications and forms in-house—Heimark’s "biggest must-have." Sy.Med’s staff possessed a medical background and a solid understanding of Cooper Clinic’s needs. Additionally, OneApp allowed Cooper Clinic to import provider data it had warehoused in the old credentialing software, eliminating the need for hours’ worth of data re-entry. Automated Credentialing Now, instead of filling out each form manually, Heimark needs only to enter a provider’s information once, and OneApp automatically completes subsequent credentialing applications. The completed applications and all required attachments are then printed and sent to the provider for approval and signature in a process that takes hours rather than days; often, forms are ready for provider signature the same day the information is entered. The printed documents are then forwarded to the appropriate healthcare organization for verification and acceptance. Why the hurry? The faster a provider is enrolled, the faster he or she receives his Medicare, Medicaid and other insurance reimbursements—and the faster that funds are brought into the clinic, Heimark says. The most labor-intensive part of the process was bringing a new provider on board, Heimark says. "I would cringe," she recalls. "For one provider to get all of his or her initial provider credentialing paperwork done took at least three days. It was worse when several providers started at the same time." Now, if Heimark receives the provider’s file in the morning, she uses OneApp to scan all appropriate documents and enters the provider’s personal and educational information only once. She can automatically complete and print all of the necessary applications and forms, flag them for signature and get them into the provider’s hands by that afternoon. When Heimark needs to confirm an individual provider number to a hospital, radiology department or group insurance plan, she can do so with a few keystrokes, obtaining all the information she needs at the desktop. If an insurance carrier or a hospital needs verification of a provider’s education or certification, Cooper Clinic staff can print out a copy of the scanned document and fax it, or attach it to an e-mail, rather than run to the file cabinet to retrieve another piece of paper. Bonus Applications For instance, provider enrollment for one insurance carrier was set to expire Dec. 31 for most of the clinic’s physicians. That meant Heimark and one other staff member would need to update more than 100 forms. Without the credentialing software, this would have translated to a significant amount of overtime to complete the job, Heimark says. Had Cooper Clinic missed the deadline, the insurance carrier would have paid a lower fee—or none at all—affecting the clinic’s bottom line. "We were able to get the required applications completed and in the providers’ hands for signatures within a few days and meet the deadline. Manually, that would not have been possible without a huge amount of overtime," Heimark says. "Between the two of us, we had those renewal applications pumped out and ready to go to the physicians within a few days." Heimark has never had any downtime with OneApp, and it integrated seamlessly into the clinic’s existing mainframe. She receives regular updates of new functions and features, and can download the upgrades via the client support section of Sy.Med’s Web site. "Since we’ve had the credentialing software in place, it saves my time and brings funds to the clinic faster. The quicker we get our applications in, the quicker we receive money from insurance carriers," Heimark says. For more information about OneApp from Sy.
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