For provider groups that have been able to secure delegated credentialing agreements, Newport has a delegated credentialing team who’s sole task is to manage the delegated credentialing process. By utilizing the CAREdelegation software module, the Newport team is able to create and format payer specific delegated rosters and to automatically populate each of these rosters directly from CARE. The Newport team then works directly with your payers to reconcile rosters each month.
- Eliminate multiple spreadsheets to satisfy each payer’s unique requirements, Newport will format, create, and maintain rosters for all payers.
- Validated provider data stored in CARE populates each of the payer specific rosters.
- Newport’s QA team reviews payer specific rosters for accuracy.
- The Delegation Team submits payer specific rosters to the payers.
- The Delegation team conducts regular and rigorous follow up on all payer specific rosters.
- Once Newport receives all payer specific rosters, the Delegation Team reconciles them based on submitted information.
- All updated delegated information is recorded into CARE for future management.
Delegated credentialing is the process insurance payers go through to delegate the Primary Source Verification process to a provider/hospital group in exchange for expediting the credentialing timeframe. The contract is an agreement that the facility validates all their providers’ demographic/credentialing information, which streamlines and speeds up the enrollment process. The facility must also meet annual delegated credentialing audit requirements.
Large groups exceeding 100 providers often set up delegated contracts with health plans in order to ease the burden of submitting hundreds of provider applications which include spreadsheets with the applicable provider data needed for enrollment. Entering into and successfully running a Delegated Credentialing Contract program is a significant undertaking. It requires highly knowledgeable credentialing staff with expert negotiating skills.
Newport’s cloud-based credentialing and provider enrollment platform, CARE, makes managing data and delegated contracts significantly easier. CAREdelegation was designed to allow users to easily create and populate payer specific delegated credentialing rosters. CAREdelegation allows users to develop customized delegated credentialing rosters to meet the delegated credentialing roster requirements of each insurance payer. The following benefits come from using CAREdelegation:
- Click, drag, and drop creation of payer specific delegated rosters.
- Develop and store payer specific delegated credentialing rosters.
- Store delegated credentialing rosters for repeated use.
- Auto-populate delegated credentialing rosters with all payer specific required data elements.
Newport’s highly knowledgeable credentialing specialists will work on our client’s behalf to individually negotiate each contract including the service level agreements / requirements that the provider group and payer(s) need to follow. Our specialists will closely monitor submission status to ensure the payer(s) have processed all requests correctly. In the event a delegated credentialing roster is returned, our team will work to ensure timely reconciliation. Newport’s credentialing specialists will also work to ensure policies and procedures are accurately maintained an all work is completed which is necessary to pass yearly audits performed by the payer(s).
A Credentialing Contract program is a significant undertaking. When successfully managed, the benefits can significantly improve an organization’s efficiency, patient satisfaction scores, and profitability. Newport’s CAREdelegation software and highly experience credentialing specialists can make this otherwise tedious process significantly more manageable.