Thought Leadership

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Q&A: Leveraging the Cloud to Improve Provider Enrollment Processes

Allyson Schiff, Newport Vice President of Operations, discusses the importance of leveraging the cloud to improve your provider enrollment processes.

Q. How can cloud-based technology help improve the provider enrollment process?

A. A successful provider enrollment initiative must be proactive. This means continuous follow-up on outstanding applications and claims.

Relying on Excel, Word documents, or lists to manage this process is simply no longer feasible in today’s highly complex provider enrollment environment.. For midsize organizations, and especially larger organizations with hundreds if not thousands of providers, it is nearly impossible to manage credentialing and enrollment manually. When administrators implement a cloud-based provider enrollment and credentialing solution, the tool will drive the user to become more efficient and enroll their providers faster. Faster enrollment means faster revenue.

Q: How does cloud-based technology differ from traditional legacy software?

A. It is not uncommon for legacy credentialing software applications to rely on an outdated technology infrastructure. Known as “client-based servers,” these legacy systems are installed on-site and are not able to provide enterprise-wide access or reporting capabilities. Even with the best people using a client-based server system, makes enterprise-wide data management difficult, if not impossible.

Cloud-based systems provide real-time access to enterprise-wide enrollment data for true multi- location enrollment statistics. Authorized users can access the system by logging into a portal via the Internet. Provider data including names, background information, and copies of documentation are securely stored within these systems for instant access by those who need it in real time. When utilizing a cloud-based enrollment system, your vendor partner (and in-house team) can closely track automated claims on hold and work to pursue a resolution. These systems also offer detailed analytics available with just a few clicks on the keyboard.

Q: What other areas within an organization can benefit from access to enrollment information?

A: Utilizing cloud-based technology, organizations can extend access to enrollment information to others within an organization such as patient schedulers. By ensuring that schedulers have real-time, participating status provider enrollment data at their fingertips (whether the provider is participating, non-participating , or is in process of becoming participating at one or many locations), costly and unnecessary claims denials can be avoided. With up-to-date information in hand, if a patient scheduler discovers at the time of scheduling that a provider is not enrolled, the patient scheduler can schedule the patient with a participating provider and therefore avoid a costly claims denial.

Q: What if we are outsourcing our provider enrollment process?

A: Whether managing enrollment in-house, or outsourcing with a provider enrollment partner, there are significant benefits associated with cloud-based technology. With the right processes and cloud- based tools in place, lost revenue due to provider enrollment eligibility issues can be significantly reduced, if not eliminated. Having a cloud-based software system in place that allows schedulers to easily view provider enrollment status as patients are being scheduled is essential to achieving long- term financial success.


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