Over 173 million Americans are in an NCQA-accredited health plan. NCQA accreditation helps give consumers peace of mind that they’re investing in high-quality healthcare. But maintaining accreditation involves many steps, including holding regular credentialing committee meetings to review and evaluate providers’ credentials.
Just like everything else in healthcare, credentialing committee meetings are rampant with inefficiencies. Solving for those efficiencies can streamline the last leg of the credentialing process, ensuring more confident approvals and fairer rejections. It can also help credentialing managers perform well in front of the medical directors and other providers involved in the proceedings.
Below, we share our tips for running more efficient credentialing meetings and making the most of your committee’s precious time.
What are credentialing committee meetings?
All accredited health plans require credentialing committee meetings. These meetings play a critical role in protecting patients, enhancing clinical effectiveness, and ensuring quality of care. During meetings, a team of medical professionals gathers to review and evaluate providers’ credentials and issue a decision on whether or not they meet the agreed-upon credentialing requirements. Importantly, to maintain objectivity, these medical professionals are not affiliated with the plan. Their work is especially important in cases where a provider’s file has been flagged for potential concerns. Most meetings take place monthly and are held in-person or via video call or conferencing.
What are the common pitfalls of running these meetings?
Several pitfalls can arise during a credentialing committee meeting, but many pop up during the preparation stage. It takes methodical preparation to run an effective credentialing committee meeting. That might include organizing provider data ahead of time and keeping provider information up-to-date. This advanced work is all the more important when you consider that committee members are providers themselves and thus already time-strapped. You can reduce their burdens and workloads by ensuring credentialing meetings go smoothly.
Tips for running a more efficient credentialing committee meeting:
Credentialing committee meetings must meet a specific set of regulatory and legal requirements, and that’s easier when time is managed appropriately and matters are communicated clearly. Proper preparation makes a big difference when it comes to putting together an efficient and effective session. Here are our top tips for running a smooth and successful credentialing committee meeting:
- Establishing policies and rules
- Collecting and summarizing information
- Evaluating and recommendations
Granting or denying privileges
These steps help ensure that members can get through the number of files assigned in a given session. They also reduce the risk of mistakenly rejecting or approving an application due to lack of clear information. Though time-consuming, adequate preparation can reduce bottlenecks and streamline this important process.
How CertifyOS can help streamline preparations for credentialing committee meetings:
CertifyOS is a first-of-its-kind provider intelligence platform, powered by API integrations and hundreds of verified data points. We unlock insights and power performance to help organizations, payors, and health systems rapidly scale their companies while keeping up with the demands of the industry.
“Common yet avoidable credentialing mistakes can end up costing providers, health insurers, and hospitals more than $2.1 billion per year. Our platform enables organizations to avoid the pitfalls of provider credentialing and streamline meeting preparation, ultimately saving them valuable time and resources.”
-Carla Simmons, Credentialing Leader at CertifyOS
Here’s how we do it:
Our intelligent network management solution leverages one intuitive platform that gives your team direct access to hundreds of curated provider data points and insights, so you can run better, faster, and more efficient credentialing committee meetings. Visit this page to learn how CertifyOS unlocks the power of provider intelligence.