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Provider On-Boarding: Does Provider Experiences Matter? If Yes, Let’s Talk Session Code: WE09 Time: 10:30 a.m. – 12:00 p.m. Total CE Credits: 1.5 Presented by: Alicia Mendez, CPCS, CPMSM
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Provider On-Boarding: Do Provider Experiences Matter? ™
By Alicia I. Mendez, CPCS, CPMSMPresident & CEO AIA Credentialing & Consulting Services
Unequivocally!
Provider Satisfaction =
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Learning Objectives
Illustrate why provider experiences matter to the success of onboarding
Identify characteristics of solutions that fail to provide transparency & engage the provider
Propose tools/guides to assess or improve your processes.
Starts & Ends with us
Privileging
Provider EnrollmentOnboarding
MSP/MSO/
MSS
What does On-boarding Mean?
Introduction/Start 40
Application 25
Credentialing – PSV/ Privileging / Membership 20
Payor Enrollment 10
Re-Credentialing 5
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Introduction or START
• Marketing• Campaigns
RecruitersRecruiters
• Dept. Chair• CMO/Admin
InterviewsInterviews• Pre
Application• HR
Vetting BeginsVetting Begins
Application
Paper OnlineVS
PSV
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Provider Enrollment Cycle ™
How do they know???
PrepareApplication
PrepareApplication
Review/Approval & Signature by
Provider
Review/Approval & Signature by
Provider
Send Application to Payer
Send Application to Payer
Follow-up with Payer
Follow-up with Payer
Payer ID & Effective DatePayer ID &
Effective Date
Provider Enrollment
CAQH
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Re-Credentialing, etc…
Management of cycles
PSV – conducted by MSO/MSP/MS
Communication of PSV process
Communication of Completion (approval/denial)
Expireables
Ongoing Monitoring
What about the current status-quo
FAILS TO ENGAGE PROVIDERS???
Initial Application or Starting Point
Primary Source VerificationProvider Enrollment
Re-Credentialing/Continued Relations
How can we do it better?
“Let me COUNT THE WAYS”
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Application Solutions
Solutions to PSV
PE Solutions ™
How is enrollment performed?
What software or program do you utilize to assist in the enrollment process?
The Basics
• Organization Name• Tax Identification Number• Address (complete address)• Phone & Fax• Contact Email• Contact person responsible for clarifying enrollment question
(specific to TIN/Payer assignment)
Do you have education process/policy which concurrently reviews credentialing and enrollment updates/trends? If so, please provide.
Do you utilize CAQH?If yes, please explain how the CAQH database is utilized.
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PE Solutions Continued
Solutions to manage Re-Credentialing & Ongoing Tasks
Daily Expireables 10
Overdue Expireables 1
Expireables within 30 Days 30
Expireables within 60 Days 15
Expireables within 90 Days 150
Hit “OK” to send Applications
OK
Expireables and Ongoing Monitoring
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Expireables and Ongoing Monitoring
Expireables and Ongoing Monitoring
Lets re-cap some of the tools
Establishing or Maintaining your Onboarding Process –Checklist
PE Assessment tool
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Selecting and leveraging technology.• Getting buy-in from the right mix of stakeholders is essential. All
departments that will be impacted should be consulted and/or asked to participate.
• It’s a team effort. The right mix of people, process and tools is essential and each organization needs to figure out what the right mix should be for their organization.
• You can’t improve what you can’t measure. Make sure a vendor’s solution allows you to measure and adjust processes as needed. Get consensus on what will be measured and how results will be shared and used.
• Resistance to change should be anticipated…...minimize resistance by communicating why it’s needed along with specifics around how changes will help, and how change will be managed
• Integration should be simplified. The ability to connect to other hospital systems should not be overlooked.
Selecting and leveraging technology (cont’d).• Don’t shy away from leading edge solutions…..and avoid bleeding
edge technologies.• Web technology is ubiquitous. Vendor’s solutions should be fully
web based to allow clients to leverage a solution across an organization. Unlimited user license pricing should be part of your license agreement.
• Beware of the ‘that’s how we do it here syndrome’….. a vendor solution should facilitate making use of industry best practices while allowing also allowing providing flexibility for truly specific client needs.
• Would you buy a car without test driving it? Some vendors are prepared to conduct well-defined low-cost Proof of Concepts for serious prospects.
• Speak with vendors’ clients. They are often willing to share their experiences…..good ones and otherwise. Some clients are even willing to host a site visit.
Questions?
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Feel free to REACH OUT
Alicia I. Mendez, CPCS, CPMSMPresident & [email protected]
AIA Credentialing & Consulting Services285 Westside AvenueJersey City, NJ 07305Tel: 201-435-9105Fax: 201-435-9106
Visit us on the webWWW.AIACCS.COM
Special Thanks
Haejune AntequeraMike Levine
Virginia LopezLuis Mendez
Shirley ThompsonHospitals, Surgery Centers, Large multi-specialty groups
MSP’s everywhere
Provider Enrollment Process Details Collection Form
Created by AIA Credentialing & Consulting Services
Entity Structure Details
Organization Name
Tax Identification Number
Address (complete address)
Phone & Fax
Contact Email Contact person responsible for clarifying enrollment question (specific to TIN/Payer assignment)
If multiple TID numbers exists the above mentioned information is needed along with a copy of the currently utilized w-9
☐Single Specialty Group
☐Entity *
☐Group Multi-Specialty Group
☐Hospital system*
☐Other ___________________________* Kindly provide brief narrative describing entity structure, including ownership details.
You may make additional copies of this page for each respective tax if the details are different
Provider Enrollment Process Details Collection Form
Created by AIA Credentialing & Consulting Services
Department Details
# of associates dedicated to enrollment function. Provide titles, and if any are certified.
How is enrollment performed?
☐Payer is assigned to associate
☐Practitioner is assigned to associate
☐Other, Explain or provide applicable policy
Who do you perform enrollment for?
☐Practitioners once they are approved by the BOT, and designated by policy
☐Practitioners limited to hospital/facility based clinics
☐Groups designated by the system
☐Other, Explain _________________________________________________
What software or program do you utilize to assist in the enrollment process?
What “core” reporting mechanism is utilized to track the steps in the enrollment process? Define/provide core set of reporting and or any reporting details.
Policies and procedure, Forms
Kindly provide any policy related to the enrollment process and related forms and or visual tools utilized by the staff for processing. For example(i.e Request for service form, enrollment policies (from notification to begin enrollment through the obtainment of provider ID and effective date), flowcharts, delegation, quality review prior to payer submission, etc.)
What functions is your department responsible for?
Primary source verification (credentialing) ☐initial ☐re-credentialing
Provider Enrollment ☐demographic changes ☐initial ☐re-credentialing
Maintenance of repository for ☐PSV ☐PE ☐Both
Provider Enrollment Process Details Collection Form
Created by AIA Credentialing & Consulting Services
Payer Details
List of Payers Kindly provide list of payers which identify if the respective TID retains a group contract (advise if delegation is an attribute of the agreement) or, individual contract. If collection of sub product (specific payer ID) is required, sub products must be listed on the Payer listing
Payer repository Provide the policy or document which indicates how the payer specific details are maintained, who is responsible for maintaining them, and how often updates/confirmation are sought.
Payer application/Details
What specific form (application/par form) is required by the payer?
What specific supporting documents are required, per payer?
What if any specialty, allied health practitioner or ancillary service providers are prohibited from participating in the network (closed-network)?
Process Details
Do you have written policy and procedures that explain how the credentialing/enrollment process is executed? If so, please provide.
☐YES ☐ NO
Do you have education process/policy which concurrently reviews credentialing and enrollment updates/trends? If so, please provide.
☐YES ☐ NO
Do you utilize facility specific (initial & re-credentialing ) applications? If so, please provide copies of applications, checklists, and letters utilized to solicit information or supporting documents from the practitioner(s)?
☐YES ☐ NO
Are you responsible for maintenance of the practitioner repository?
☐PSV ☐PE ☐Both ☐YES ☐ NO
Do you utilize CAQH? If yes, please explain how the CAQH database is utilized.
☐YES ☐ NO
Print Name Person completing assessment
Signature and Date
Provider/Practitioner On-Boarding ™
Clinical Leadership Project Timeline Description/Notes Start Date End Date
Communication with clinical leadership or their administrative staff on the required documentation to initiate the onboarding process
Understanding, how departmental rules and regulations affect initial recruitment and vetting process
Medical Staff Office/Medical Staff Professional Project Timeline Description Start Date End Date
Develop/Maintain step by step credentialing process for applicants and or applicant's staff detailing the onboarding process to include highlights, and timeframes leading to approval (i.e. File processing, PSV, Chairman review and recommendation, Committee(s) and governing body approval).
Develop/Maintain the onboarding process (Concurrently Update)
Develop/Maintain the PSV process (Concurrently Update)
Provider Enrollment Project Timeline Description Start Date End Date
Complete a PE assessment
Define Hand off (if required) between PSV completion/appointment and initiation of PE
Define reporting Structure (Standing Reports)
Define your Payer list
Determine or develop your PE approach base on PE assessment
If participating in a Delegated Agreement: Define Hand off (is required) between PSV/appointment and Initiation of PE
Reporting Structure (Standing Reports)
Understand financial implications of payer list (who is your priority)
Recruitment Project Timeline Description/Notes Start Date End Date
Determine Utilization Parameters for recruiters to track their provider communication of prospective providers (i.e. permission granted of updates versus view only inclusion of key stakeholders).
Development/Maintenance of Recruitment
Include key stakeholders in communication process review
Initial/Ongoing Communication with Clinical and Entity or Leadership
Maintenance of Recruitment
Marketing Material
Other Project Timeline Description: Always include key stakeholders Notes
Departmental Leads
Finance
Infection Control
Medical Records
Performance Improvement/Quality
