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

CRD-WHP-Understanding-Credentialing-and-Enrollment-Processes

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 the payers’ specific accreditation and regulatory requirements can help you and your team of medical services professionals further ensure timely processing of provider applications. This white paper will explore: the processes payers conduct to evaluate and enroll healthcare providers; common challenges in provider enrollment and how to solve them; and tips and techniques to achieve delegated credentialing.

Delegated Credentialing in the Medical Staff Services Department

crd_article_delegated_credentialing_in_the_MSSD

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 Greeley Company’s Credentialing & Privileging Compilation

crd_guide_credentialing-and-privileging-compilation

The Greeley Company has served administrative and clinical teams in more than 700 healthcare organizations nationwide within the past three years—including hundreds of credentialing and privileging-related projects. Our consultants also present at national and regional conferences and seminars throughout each year, serve as subject matter experts for various publications, and author dozens of resources including articles,… [Read More]

Multifaceted Engagement Leads to Credentialing, Privileging, and Bylaws Improvements

crd_casestudy_multifaceted-engagement-leads-to-improvements

The Chief Executive Officer/General Counsel and Credentials Chair of a 25-bed, physician-owned surgical hospital in the Midwest both attended one of The Greeley Company’s national seminars, The Credentialing Solution, in San Diego in early 2015. They were impressed with the content of the seminar and followed up with The Greeley Company about conducting a gap… [Read More]

Customized Core Privileging Produces Compliant, Effective Privileging System

crd_casestudy_customized_core_privileging_project

During a July 2014 Joint Commission survey, one of CHRISTUS Santa Rosa Medical Center’s specialty hospitals experienced some specific compliance challenges related to their core privileging forms. Recognizing that the entire system was at risk of a repeat of these findings across all of their sights—and aware of Greeley’s national expertise in the area of… [Read More]

Outsourcing As A Solution to Your Credentialing Woes

Historically, the medical staff services department (MSSD) has operated behind the scenes in healthcare organizations, with few hospital workers outside the department fully understanding the extent of its responsibilities. However, the MSSD is truly the nucleus of the hospital, as it is responsible for everything from credentialing and privileging practitioners and meeting pertinent accreditation requirements… [Read More]

High-Risk Credentialing: Best Practices for Temporary Privileges and Locum Tenens

crd_article_high-risk-credentialing-best-practices

In today’s challenging healthcare environment, certain influencers intensify the need for the routine use of temporary privileges and/or the ongoing use of locum tenens. A challenging recruitment and retention environment, as well as patient, community, and hospital needs, produce understandable pressure to quickly get certain practitioners and specialties credentialed and privileged. Overuse or abuse of… [Read More]

Credentials File Audit Leads to Multiple Discoveries

crd_cred-file-audit-leads-to-multiple-discoveries

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]

Providing Experienced, Skilled Management Support to Hospital Leadership Team

A 330-bed Midwestern acute care hospital had experienced many of The Greeley Company’s services, including onsite consulting, core privileging assistance, participation in national seminars, and membership in The Greeley Membership Program. When their medical staff services department (MSSD) supervisor and two other experienced medical services professionals (MSPs) left the organization in December 2014, leaving no experienced… [Read More]

Versatility and Teamwork Lead to Extended Stay, Multiple Roles

A 450-bed, cutting-edge, urban hospital on the East Coast initially sought an interim credentialing specialist from The Greeley Company to staff a 90-day assignment to assist with credentialing during the summer—their busiest months of the year. As circumstances have evolved, the client has asked to have the same interim staffer stay on to work on other… [Read More]