Certify achieved a 29% annual costs savings for Oscar Health.
Oscar Health, a national health plan, faced significant challenges
in their credentialing process:
Problem: Oscar Health, a national health plan, faced significant challenges
in their credentialing process:
1-Manual delays:
Manual credentialing caused delays, hindering expansion.
2-Error Prone:
Managing the scale of credentialing and regulatory updates manually led to errors.
3-Data issues:
Unstructured data made reporting diicult.
Growth detractor:
Without integration with primary sources, every stage of Oscar Health’s credentialing process required manual verification, resulting in lengthy turnaround times and administrative ineiciencies.
Compliance challenges:
Regulatory Inconsistencies:
Oscar’s manual infrastructure couldn’t ensure timely, accurate compliance with NCQA and state policies, making audits cumbersome and leading to expired credentials (licenses, DEA certificates & board certifications) being included in their network.
Limited Monitoring:
The lack of continuous monitoring increased the risk of including providers with expired credentials or sanctions in the network, opening Oscar to liability and potentially impacting patient care.
Inaccurate & unreliable data:
Without scalable infrastructure, maintaining accurate provider data was cumbersome, leading to inaccuracies in directories and denied claims.
Oscar Health partnered with Certify for:
Real-time credentialing and verification
Automated network data exchange
Configurable workflows to reduce costs
Opportunity:
Foundational Provider Data Infrastructure: Certify implemented real-time credentialing, drastically reducing turnaround times, allowing Oscar to quickly scale their networks.
Primary source integrations and data customization added eiciency to downstream systems.
Innovative Network Integration: Certify provided on-demand file verification, reducing verification times from weeks to minutes increasing both accuracy and transparency.
An intelligent monitoring system flagged problematic providers in real time,
ensuring compliance and peace of mind.
Comprehensive Workflow : Certify’s programmatic logic reduced Oscar’s operating expenses by enabling configurable workflows, automated recredentialing timelines, and integrated credentialing committees.
Results:
Reduced Credentialing TAT's to 3 days from 29.4
Monitored > 85,000 providers
Saved $150,000 annually in administrative costs
Fully Credentialed > 38,000 providers
Decreased duplicate provider issues and escalations
Reduced wrongful file inclusion and audit fees
Reduced manual, error-prone tasks
Enabled focus on strategic growth opportunities
Total annual savings: $733k
Certify achieved a 29% annual costs savings for Oscar Health.
Interested in learning how Certify can help your organization achieve similar results. Book a Free Demo today or email sales@certifyos.com
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- Case StudyProblem: Alma, a national network of mental health care providers, faced significant challenges in their provider credentialing and monitoring process; including: Onboarding Timelines: As incoming provider volume outpaced their credentialing infrastructure, Alma’s network growth stalled, resulting in lost revenue and delays in patient care. Inflexible Systems: Inability to adapt file formats led to bottlenecks - preventing new providers from being credentialed, and existing providers from being continuously monitored - increasing sanctioned or incorrect provider data inclusion, and hindering network growth. Manual Review: Inaccurate and unreliable data: Without scalable infrastructure, maintaining accurate provider data was cumbersome, requiring 3.5 weekly hours of manual review. With over 10% of files aected with errors, reliability was always in question, and the prospect of audits became a concern. Alma implemented Certify's credentialing and monitoring solutions and saw: Quick and eicient provider network growth due to real-time credentialing and monitoring. A reduction in onboarding friction driven by on-demand file verifications which completed in minutes, not weeks. This improved provider relations and increased data accuracy and reliability. Manual error review by Alma's Credentialing team was no longer necessary, due to programmatic logic and ongoing workflow configuration removing bottlenecks, and quickly enabling provider network expansion. Results: Reduction in Credentialing TATs (from 17 days to 3) Audit preparedness via Certify’s NCQA certification Reduction in provider escalations around prolonged credentialing times Time reduction on labor to QC and resolve errors and delays Enabled focus on strategic growth opportunities About Certify & Alma: Together, both companies have a shared focus on improving the mental healthcare provider and client experience, ultimately enabling better care delivery for therapy seekers. From alignment around automation and configurability to improving provider networks to joint alignment around meeting the needs of clients, Certify is an extension of their customers, a partner constantly adapting and growing our product to meet the broader goals of the industry. If you’re interested in modernizing your provider network operations or learning more about our data first approach scan this QR code or email us at sales@certifyos.com to schedule time with one of our provider data specialists.