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:
-
Follow the four steps of credentialing committee meetings.
According to the Credentials Committee Employee Handbook, it’s essential to organize your meeting into four distinct stages:
-
-
- Establishing policies and rules
- Collecting and summarizing information
- Evaluating and recommendations
-
Granting or denying privileges
-
-
Include summaries with each application.
Compose clear and direct summaries of all applications to be reviewed. That way, everyone can easily access the critical information they need. -
Keep data organized.
You can streamline discussions by systematically organizing all provider files for easy review—especially the documents you need to support any identified issues. Member chairs can also consider organizing provider data into different categories, such as those that will require little discussion and those that may require more thoughtful deliberation and review. -
Provide committee members with certain information in advance.
You should make any files that have been flagged for concerns available to committee members in advance. This allows members adequate time to review the files ahead of the meeting. -
Establish clear membership and privilege criteria.
It’s important to establish objective criteria with which members can grant or deny membership or privileges to providers. These criteria may include license and training, board certification, ability to perform privileges, and evidence of competence. In most cases, denying membership or privileges should only occur when there is evidence of demonstrated incompetence or unprofessional conduct. -
Remove all identifying information.
It’s important to protect the privacy of providers under review and to mitigate the risk of implicit or explicit bias. You can keep the review process as objective as possible by removing all identifying information from provider documents, including their name, gender, nationality, race or ethnicity, and languages spoken. -
Treat providers fairly, but not necessarily equally.
Not all provider files are equal. For example, a provider with no gaps in their training or red flags on their file will not be assessed in the same way as a provider with trouble spots in their data. Though it’s important to treat each file fairly, differences in provider histories can lead to different credentialing outcomes. Be sure to let the existing information and data drive the discourse, when necessary.
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:
- Bulk approval: With CertifyOS, medical directors can bulk-approve clean files, allowing the committee to spend more time reviewing files that require additional consideration. Non-clean files are then tracked in the credential committee section for review.
- NPDB data auto-population: All relevant data from provider reports in the National Practitioner Database (NPDB), including settlement amounts, actions, dates, and so on, are automatically generated to the credentialing committee’s notes. That means your group doesn't have to waste precious time reading through the report manually. Data auto-population also works to reduce data errors that can otherwise lead to a committee making critical mistakes.
- Define significant report thresholds: Not all reports are equal. For example, a 20-year old malpractice claim for $10K won’t warrant the same consideration as a $200K claim reported just last year. With CertifyOS, you can create a customized logic that defines which thresholds are important to your committee, including claim amounts and dates.
- A single source of truth: CertifyOS’s platform lets you track and host all committee actions, files, meeting notes, and more in one convenient, centralized place. Committee members are also able to convene on the platform, both during committee sessions and for any future audit purposes.
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.
