Outsource Insurance Credentialing

Responsibility for outsourcing an important business function can be a daunting decision.  Whether you are a seasoned manager of a large organization, or a solo practitioner starting a new medical practice there are some functions that are best outsourced to let you focus on your core business duties.  This multi part article will discuss services best suited for outsourcing, typical costs of outsourcing, pitfalls of outsourcing, and steps for finding the best fit outsource partner.  The focus of the article will be on outsourcing medical credentialing services, specifically payer provider enrollment and primary source verification.  

First, consider what business services are a best fit for outsourcing.  Tasks most suited for outsourcing generally fall into three categories.  They include:

• Specialized services.  Business functions that are highly specialized requiring unique training and skill sets are good candidates for outsourcing.  Functions such as IT management typically are at the forefront of this category because not all organizations, especially small startups can afford a full time IT person.  Credentialing falls into this category as it is a unique service requiring someone with specialized knowledge of the processes in order to successfully maintain your physician’s credentials with hospitals, health plans, and other healthcare organizations that require credentialing of your organizational providers.  Done haphazardly can have a dramatic impact on your revenue cycle.

• Repetitive.  The repetitive nature of completing insurance credentialing applications for physicians along with the follow-up necessary to complete the process with payers further makes this function a prime candidate for outsourcing.  The routine tasks of maintaining documents, keeping CAQH profiles up to date, and ongoing monitoring of credentials are time consuming tasks best left to someone with automation and specific focus on these duties.   

• Requires expertise.  Hiring experts in a business role that is outside of your core business is often distracting and the third category of services best suited for outsourcing.  Organizations that are centered around providing professional healthcare services need not recruit, retain, and manage experts in credentialing.  Outsource these functions to service partners whose core competency and business is credentialing.  Credentialing experts can shore up your revenue cycle management by making sure your providers are enrolled with health plans in a timely manner, and complete primary source verification in support of your privileging process to ensure your hospital has a well rounded and qualified medical staff.

Insurance credentialing is a fit for outsourcing in all three categories.  Any healthcare organization should evaluate outsourcing this function to a business partner whose core business function is credentialing.  

Many healthcare providers and administrators consider the payer enrollment process a “one and done” type of project.  Nothing could be further from the truth.  Maintaining credentialing files internally that include ongoing record of CME, updates to expired documents, maintaining CAQH, commercial insurance and Medicare revalidation of enrollment records, updates to enrollment records when you add a service location or make other business changes, and support to the billing office when claims denials happen due to incomplete enrollment records at insurance companies are all ongoing services that your credentialing department, or outsourced credentialing partner, need to handle on an ongoing basis.  What information is maintained in a provider credentialing file?  Check out our previous blog post on what to maintain in your physician’s credentialing files.

To get an idea of the time spent on insurance credentialing, let’s consider a solo practice start-up and the need to be contracted with health plans.  Most medical practices contract with 10 – 12 insurance networks.  Each of these networks require a credentialing and contracting process that ranges from a quick electronic submission of data to lengthy paper forms that require manual completion.  Either way, there is also a great deal of administrative follow up to ensure the process is moving along and moving along correctly.  When evaluating outsourcing versus a do-it-yourself approach, physicians can expect to spend 4-6 hours on each insurance network application to complete the process.  Consider the value of 50-60 hours of your time versus the cost of hiring someone capable of completing the process quicker and more efficient that you can individually.

At nCred, we focus strictly on physician and non-physician practitioner credentialing services.  We offer complete management of your credentialing needs by maintaining all of your provider credentials in one central location and managing the payer provider enrollment process and record maintenance.  Our cloud based software platform allows you instant access to all your credentialing files, data, and documents.  Our unique platform also allows complete transparency in the services our staff is performing on your behalf by allowing you to monitor all activities performed and to interact with our staff.

About nCred

nCred is a leading national provider of healthcare credentialing services.  nCred has assisted thousands of providers and healthcare organizations throughout the country with the payer provider enrollment process.  The successful implementation of leading technologies combined with experienced credentialing staff produce excellent results for nCred clients.  Contact us today at (423) 443-4525 or fill out our request for information form to discuss how our services can benefit your organization.