Understanding Credentialing and Enrollment Processes: Healthcare Organizations vs. Health Plans

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As someone who manages or oversees provider credentialing and payer enrollment for your hospital or healthcare organization, you understand the value of maintaining efficient processes across departments to save time, reduce costs and ensure providers are granted privileges as quickly as possible. Health plans (also known as managed care organizations) strive for similar goals. Understanding… [Read More]

Credentialing Compliance and Accreditation Tips for the New Year

NOTE: This post originally appeared on the Greeley Membership blog.
happy-new-year-2017

January is a time when many of us reflect on the happenings of the previous year and will set new goals for 2017. Some of the top resolutions include spend more time with family and friends, exercise more, learn something new, and get organized. As MSPs, it is also a good time to evaluate current… [Read More]

Delegated Credentialing in the Medical Staff Services Department

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There are several reasons why a commercial payer, such as a managed care organization or health plan, may consider delegating all or part of its credentialing activities to qualified business partners such as IPAs, PHOs, CVOs, medical societies, even other health plans. However, a growing trend observed by The Greeley Company is for hospitals and… [Read More]

The New Paradigm: Delegated Credentialing in the MSSD

NOTE: This post originally appeared on the Greeley Membership blog.

The Situation: The number of employed practitioners at your hospital is increasing. Provider enrollment with the managed care payers is time-consuming and long delays are being encountered. A significant loss of revenue has been incurred over the last year due to the inability to bill for patient care services while your practitioners waited to be… [Read More]

Credentials File Audit Leads to Multiple Discoveries

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After performing some random credentialing file reviews, a multi-entity health system of 200+ beds that is part of a larger academic medical system discovered that several of their credentialing files were incomplete and/or lacked appropriate documentation. The organization was concerned that these findings were not isolated and that many of their credentialing files might lack the… [Read More]

Credentialing Under Construction

A contractor is building several new homes in my community. I have been watching the excavation and grading of the property, the concrete basements being poured and the walls going up. All of these steps are necessary to achieve a good solid foundation on which to build the home. Many of us may never see… [Read More]