For many traditional IT solutions, “human automation” and outsourcing are at the center of provider network management.
Why? The legacy systems that handle credentialing, licensing and payor enrollment were built primarily with security and compliance in mind, without contemplating integrations, APIs or workflow automation.
In practice, this looks like a large offshore team charged with taking screenshots to turn primary source verification files into PDFs and following a very standard SOP to get work done.
The impact of the “human automation” approach is two-fold:
- Lengthy turnaround times: It takes about 120 days on average to get a provider in-network.
- Application inaccuracies and human errors lead to even longer cycles for licensing, enrollment and credentialing.
Over the last two years alone, more than 3,000 digital health companies have been founded, and digital transformation is top of mind for payors and hospital systems.
The tools that are available today (along with recent regulatory changes) have made it possible for the first time to have an end-to-end provider intelligence platform that enables care delivery and reduces the administrative burden on providers.
Some of these tech stacks include:
- OCR technology to auto-fill application forms, thereby reducing human errors.
- Data scraping to automate data capture from hundreds of sources and streamline the credentialing process.
- Data pipelining to build accurate sources of prover data that enable providers to shift to 100% clinical work and 0% admin work.
So, when evaluating provider network management partners, here are some of the questions you should be asking:
- What is the turnaround time for credentialing, and what does correspondence with providers look like? If it’s more than a day or two, your vendor is likely using human automation.
- What is the files-to-processors ratio, or in other words, how many files is each person processing per day?
- What is the level of accuracy for the files? Are there rebates available if the accuracy level drops below 95%?
When selecting a partner, it’s easy to get distracted by buzzwords like “modern” or “new age” that mask the manual processes behind the scenes.
Our vision–and the standard you should expect and demand from your partners? A world where providers can be credentialed in under two minutes with one API and one provider ID.
Only then can healthcare organizations unlock insights and power performance for clinicians, teams and organizations.
At CertifyOS, we’re making this vision a reality, with frictionless licensing and enrollment, one-click credentialing and real-time network monitoring at your fingertips.