Automated, Verified Credentials for Always-Accurate Provider Data
A Hybrid Approach
For most payer organizations, credentialing and operational teams are tasked with effectively managing the provider data lifecycle with efficiency and accuracy. To maintain an unwavering commitment to care quality and equity, these organizations are up against a new generation of pandemic-era fraud, heightened scrutiny on virtual care, labor shortages, and financial volatility. This once standardized process continues to balloon into an ever-evolving regulatory challenge, often riddled with potential for errors, data gaps, and reputational risks.
Current State of Credentialing
But efficient provider data management and directory strategies are ineffective without first establishing a key point-of-view and strategy around provider data accuracy.
Let’s talk about the standard Provider Lifecycle.
But do you see the gap? What happens in the time between credentialing and recredentialing? Ask yourself: If you’re not monitoring providers’ credentials on an ongoing, continuous basis, what are you risking?
It’s simple. Without always-accurate provider data, potential fraud, waste, and abuse can leak into your provider networks – a harmful risk to not only your organization, but the entire healthcare ecosystem.
How does your organization currently manage the Provider Lifecycle?
Credentialing activities are performed internally by our own teams
We outsource credentialing activities to an external vendor, such as a Credentialing Verification Organization (CVO)
And when deciding on a potential solution, payers said they placed the highest value on data accuracy, API integration, and continuous monitoring. Yet, only 24% of survey respondents said they currently do provider verification continuously.
How the Industry Manages Credentialing Today
But what if there was a third option?
One that integrates within your existing workflows and …
Determines eligibility, quickly and accurately
Reduces time to initial credential
Eliminates error and catches issues as they occur
Saves time during the recredentialing process
Ensures a better provider onboarding experience
Feeds your provider directory with always-accurate data
It’s possible. And it starts by leveraging ongoing, automated, verified credentials with a flexible hybrid approach from ProviderTrust.
Simply put, whether you manage credentialing workflows internally or externally, our hybrid approach allows for ongoing verification of those credentialing activities that require continuous monitoring – those areas that often create the most risk and drain valuable resources within your organization.
A Hybrid Approach to Credentialing
The Provider Lifecycle
Chief Compliance Officer
“It’s only those high-risk areas that you need to monitor in real-time between credentialing applications. You don’t need to constantly validate static information like education or work history. But when you start talking about something like a disciplinary action, for example, that’s something you do want to know immediately. Technology can check those areas that are prone to change, as those same areas often expose the health plan to more risk.”
In a recent survey of 150 health plan professionals, 95% of decision-makers say they expect to increase attention on provider data management in the next 18-24 months.
Platforms like ProviderTrust can more easily operationalize continuous monitoring because of the way these workflows function, Donna Thiel, Chief Compliance Officer at ProviderTrust, said. A common misconception is that when you commit to continuous monitoring, you’re recredentialing every single detail about that provider.
But in reality, some details—like where a doctor did their residency—
It starts with Enrollment and Initial Credentialing to determine eligibility.
Providers are then moved into your organization’s Provider Directory.
After two to three years, it’s time to recredential, basically starting the workflow over again.
Once credentialed, providers move into Network Participation.
ProviderTrust is a certified NCQA-CVO. Our hybrid approach to credentialing enables you to speed the time to credential, maximizing efficiency and minimizing turnaround times.
We focus on key credentialing elements that determine provider eligibility. We deliver insights for provider information on an ongoing basis instead of the traditional credentialing process that only reviews these elements every two to three years. We are NCQA-CVO certified in these areas:
Reimagine Your Credentialing Workflows with ProviderTrust
Verification of Board Certifications
Medicare / Medicaid Sanctions
We integrate with a payer’s existing applications as they change and evolve, enabling API delivery to credentialing or provider network management platforms. With over 13 years of experience, ProviderTrust has built a reputation as a reliable partner for payers, health systems, and pharmacy organizations.
API integration to the moments and workflows
you need most.
500 million exclusion checks annually
600+ state license boards monitored
95% of initial verifications automated and delivered within
30% cost savings over traditional CVOs
43 million license verifications annually
We reduce costs by shifting away from the pay-per-credentialing event model used by traditional CVOs. With our always-accurate data, we catch duplicative provider information in your systems, eliminating redundancies within your provider networks, and saving valuable money and time.
Cost savings and efficiencies, all in one.
If you’re looking to get started with a sophisticated and continuous verification tool for credentialing activities,
we can help.
Based on a recent ProviderTrust survey, 47% of payer organizations perform credentialing activities internally, while 53% leverage a
We perform credentialing activities ourselves, internally
We outsource credentialing activities to an external vendor, such as a credentialing verification organization (CVO)
Cut down time during the recredential process, pulling down ongoing, verified credentials instantly
We reduce costs by shifting away from the pay-per-credentialing event model used by traditional CVOs. With ProviderTrust, your teams can leverage continuously automated, verified credentials for always-accurate provider data, ensuring eligibility throughout a provider’s entire lifecycle with the plan.
Hover over the diagram to learn more!
See why payers trust us to deliver continuous, always-accurate provider data.
ProviderTrust conducts DEA Registration primary source verifications (PSVs) via the US Department of Justice’s Diversion Control Division.
ProviderTrust conducts Primary Source Verification (PSV) via state board certification sources.
All available federal and state Medicaid exclusion lists are monitored.
ProviderTrust conducts primary source verification (PSV) against all available state licensing boards.
ProviderTrust monitors federal and state sanctions (exclusions) and disciplinary actions on an ongoing basis to alert you in real-time to changes in eligibility.
Hover over each module to learn more.
Hover over the photo for additional insights from Donna.
Continuously feed your directory with valid, up-to-date data on the provider
Enrollment & Initial Credential
Determine eligibility instantly and reduce time to credential
Network Participation (Ongoing Monitoring)
Catch issues as they occur, not just at recredentialing
ProviderTrust conducts ongoing monitoring to identify medical board sanctions.
Medical Board Sanctions
Hover over each module for additional information.