A medical credentialing solution means a smart system built to ensure healthcare providers by keeping track and maintaining the proper licenses and certificates to practice medicine. The provider credentialing is tedious and time-consuming as it requires monitoring professional requirements and stores a wide range of data about providers. Physician credentials data includes NPI number, i-9 documentation, EIN, and more. Medical credentialing solutions help healthcare organizations to ensure providers are appropriately licensed and can provide reliable healthcare. OSP can customize advanced insurance credentialing applications that offer CAQH Proview integration, recredentialing, medical credentialing process automation, and robust provider network management. Our integrated healthcare credentialing solution can be engineered for seamless credentialing certification management through smart integration with NPPES NPI registry through APIs.
The common bottlenecks which might slow down your business growth
Lower portability adversely affects the credentialing process workflow and provider data management tasks.
A paper-based and manual credentialing is damaging the speed and efficiency of medical credentialing.
Inefficient management of provider data storage, segmentation, data security for efficiency.
High error ratio in the credentialing certification due to manual and paper-based systems.
Inability to maintain NCQA standards for a seamless and secure insurance credentialing methods.
Inability to manage and control healthcare credentialing without proper reminders.
Leveraging advanced technology to build CAQH integrated provider credentialing system for in network providers
Credentialing and recredentialing of in-network providers are among the major segments of revenue cycle management of practice managers. The healthcare providers, hospitals, FQHCs are struggling with manual, time-consuming, and traditional medical credentialing methods. These processes are fragmented, error-prone, and far away from smart integrations such as CAQH Proview, Peer review, NPI Registry, CME credit scoring, and more. OSP can solve this challenge by offering custom healthcare solutions to automate your medical credentialing workflow in a centralized manner. In centralized credentialing, two or more than two healthcare facilities share the cost of credentialing providers saving the total cost required. Even the providers get credentialed once, making the process more hassle-free and increasing the goodwill between providers and administrators. We program the medical credentialing system as per your needs to eliminate credentialing a single provider in multiple systems while maintaining the efficiency and data integrity of credentialing to complete your provider credentialing checklist.
Provider data verification is a time-consuming task and errors cause more harm than help. It includes collecting required data from the physicians, developing the credentialing strategy, auditing the provided data for accuracy, validating the data and certificates, managing provider profiles, and following up with payers. OSP’s long-standing experience in healthcare automation allows streamlining the credentialing workflow process by automating multiple inbound processes such as provider data verification, task management, provider data monitoring, document expiration alerts, and attestation aging credentialing metrics, OIG monitoring, and more. We help you in better hospital management with medical credentialing tasks with real-time, intuitive dashboards to enhance productivity and eliminate the redundancy in the process.
Managing providers data requires a robust data management system. Provider database management with optimum data security is challenging and expensive for many providers and clinics. OSP can help you successfully access all the provider data with CAQH Proview integration. The Council for Affordable Quality Healthcare (CAQH) is a non-profit association of health insurers that collects and maintains a database of provider credentialing data. Almost 1,000 health plans, hospitals, and providers groups use CAQH ProView to streamline healthcare credentialing, improve in-network provider directories, and speed claims processing and adjudication. OSP can tailor healthcare solutions for insurance credentialing to maintain a single source of provider data across all your systems. Whether you require to send provider information into your EHR/EMR or push data to or pull from CAQH, our healthcare integrations will solve your challenge using standard HL7 messaging protocols.
Whether you are looking for Medicaid provider enrollment or Medicare provider enrollment, we can simplify the credentialing document tracking in real-time. Healthcare provider solutions should be user friendly, interactive, and manageable. It’s easy to capture prospect forms and signatures and immediately send materials through your enrollment workflow. Modern systems are capable of capturing and tracking all the required medical credentialing data and signatures at the point of contact, avoiding delays, costs, and missed enrollments. We have good experience in building HIPAA compliance solutions from scratch, where we maintain the data security standards with high regard.
Interoperability in healthcare is the key when we need to share essential provider data files through electronic data interchange (EDI). We can solve the challenge of interoperability while handling the insurance credentialing certification and licenses. OSP can program medical credentialing solutions capable of tracking, monitoring, and managing the credentialing data seamlessly. We can build healthcare cloud-based data storage to manage important files regarding the provider’s attestation and provider credentialing processes. Users need to manage primary source verification, healthcare credentialing, and privileging needs in one comprehensive solution where they can update, download, edit, and keep track of versions on the same platform. As per your needs, we can build an interactive dashboard to manage provider demographics, their experience, CME tracking, educational qualifications, NPI number, i-9 documentation, EIN, and more.
Healthcare credentialing solutions maintain a wide variety of inbound processes like document capturing, tracking credentials, maintaining the provider’s data, managing the data securely, credentialing, and provider privileging. A single platform with a centralized management system can solve the challenge of automation and task management. OSP can understand your challenges and build a smart system specifically for your business for seamless task management. We ensure the system meets medical credentialing requirements from the Joint Commission and the National Committee on Quality Assurance (NCQA). We help you eliminate administrative paperwork, expensive, time-consuming, and complex processes and replace it with a simplified healthcare credentialing solution.
A Texas-based mental health center wanted to reinvent the medical billing process and enhance approval rates which were 10% against 100 claims submitted.
It was challenging to manage multiple insurance providers for a large clinic set up for a health specialty that needs flexibility in patient billing, workflow automation, accurate claim scrubbing, and fill regulatory compliance gap.
The solution comes with-
A single point assessing system was created and geared for complete compliance of credentialing for improved quality care and overall turnaround that is a result of efficient processes.How we do it
With top-of-the-line customized solutions, our software offers outcome measurement through data classification, efficient coding, automated documentation techniques, grouping methodologies, and compliance.How we do it
A mental healthcare organization opted for our credentialing software that undertakes intelligent classification, grouping, and calculative measures to improve caregiving (caregiving) and reduce risks within the organization.How we do it
Our solutions are custom-made to the organization’s requirement with advanced credentialing software to build a solid data foundation as the starting point of all processes.How we do it
The data that can be measured can be managed. Maintaining the provider data for healthcare credentialing doesn't offer deeper insights. Analyzing this data and creating customized reports can offer actionable insights and pointers for better efficiency. We can engineer a medical credentialing solution that offers customized reporting with filters of your choice. Recovering insightful data and customize reports with top-quality features, including institutional summary, days in enrollment, facility summary, provider summary, etc. is made possible.
Recredentialing is the process of periodically reviewing and verifying your provider credential to keep the professional qualifications remain valid and current. It is one of the core challenges of the medical credentialing to its required time and error-prone nature. OSP can program smart medical credentialing solutions to help hospitals and clinics process healthcare credentialing through automation. Application review, credentials verification, and RNCC review can be streamlined in the recredentialing system.
Hospital staff usually waste time tracking dates of certifications and license expiration and focus time on what's really important. But this process can be automated. We can create a document expiration reminder module to visualize all employees quickly and who's missing certifications in one central place. This module can be built around your specific needs to automatically send email and SMS text reminders to keep everyone in the loop when certifications are about to expire. No more manually sending emails as alerts and reminders will work for you.
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