Cloud-Based Provider Enrollment and Physician Credentialing Software

Use the cloud to take over your credentialing life cycle

To help our clients proactively navigate the increasingly complicated provider data management landscape, Newport offers the industry’s first cloud-based medical credentialing software platform integrating workflow, analytics, and business intelligence: CARE. CARE enables our clients to take full control of the operational, financial, and compliance aspects of their credentialing lifecycle by utilizing industry-defining, cloud-based, revenue-centric workflow tools.

But CARE is more than credentialing software; it’s an integrated, customizable credentials verification and provider enrollment platform. It has been designed by experts with deep knowledge of healthcare-specific best practices and features powerful tools that facilitate every step of the credentialing process. No other provider credentialing software on the market can manage electronic provider data and documentation, credentials verification, enrollment, delegated credentialing, re-attestations, and credentialing edit and denials.

The CARE suite includes the following solutions.

CAREdemographics

CAREdemographics

CAREdemographics was designed with best-in-class credentialing departments in mind. As such, it intuitively reflects how these departments operate. Below are some of the key functions of CAREdemographics:

Cloud-Based Demographic Storage

CAREdemographics enables you to store all your key demographic data within a single cloud-based credentialing software repository. No longer must you update a myriad of spreadsheets and files to ensure the accuracy and accessibility of your provider data. Instead, you can use the power of our easy-to-use, cloud-based relational database to manage all your applicable physician credentialing data.

Multi-Tier Database Hierarchy

CAREdemographics empowers you to build out your credentialing infrastructure based on your organizational needs and requirements. Whether you develop your data hierarchy by Institution (health system), Group (multiple hospitals within a health system), Location (multiple service locations), Department (department within a health system and/or hospital within a health system), or Provider, your one-stop-shop—but not one-size-fits-all—CAREdemographics database reflects your health system’s true structure and operational protocols.

Intuitive Database Population and Navigation

Entering physician and provider information into the CAREdemographics database is easy and intuitive. Using various tabs, you can seamlessly transition from one screen to the next, following a workflow that mirrors credentialing best practices.

Mass Provider and Payer Updates

CAREdemographics allows you to update all providers and/or all payers using global change functionality. No longer do you need to touch each individual provider and payer record to enter new locations, Tax IDs, etc. Instead, you can update all relevant provider data with a single click of a button.

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CARElist

CARElist

CARElist was designed to answer a very simple question: Why are there workflow tools for Accounts Receivables but not for credentialing? Both are vital functions within a health system, and both affect revenue, yet most medical credentialing software has not been designed to recover lost revenue or deliver cost savings.

The answer to that question is CARElist. CARElist allows health systems to create task- and revenue-driven work lists that reflect the way credentialing truly occurs. The concept is simple. By documenting and categorizing all the activities required to credential a provider, you increase oversight, improve efficiency, and reduce the time it takes to on-board a provider. The results include a more empowered credentialing department and staff, higher levels of productivity, and most importantly, more revenue.

Below are some of the key functions of CARElist.

Task and Revenue-Driven Work Lists

CARElist provides task- and revenue-driven work lists that reflect the steps that need to be completed to credential a provider correctly.

Task Based Work Lists

CARElist’s real-time, task-based work lists are based on the steps required to enroll a provider. For example, once a task is conducted and completed, the user records their progress by clicking “Complete.” CARElist then automatically advances within the work list to the next pending task within the initial credentialing lifecycle. This process continues until all tasks have been successfully completed and the PIN has been obtained.

Users can create work lists in addition to those covering initial credentialing, including re-credentialing, contract rate, and EFT linkage work lists. This flexibility means health systems can rest assured that each provider is being closely tracked at every step of the credentialing lifecycle.

Revenue-Based Work Lists

In addition to task-based work lists, CARElist attaches the gross charges associated with a provider to the work list. By attaching gross charges and tickle timeframes to a provider, CARElist makes it easy to identify and stratify which providers have the highest revenue impact on the organization—and prioritize follow-up accordingly.

Dynamic Payer Bar

Designed to stratify all follow-up activities, the Payer Bar constantly pushes the payers with the most outstanding Credentialing In Process (CIP) statuses to the top of any relevant work lists. The result is a seamless workflow enabling the user to maximize the effectiveness of their follow-up efforts.

Tickle Timeframes

Create automatic notifications for all applicable follow-up activities using this functionality. Once you complete a follow-up activity, you can then establish a “tickle timeframe” defining the next time that you would like to conduct a follow-up activity. “Tickled out” accounts will fall off your work lists temporarily but will pop up and be flagged for follow-up based on your user-defined schedule.

Real Time Productivity Dashboards

CARElist’s real-time dashboards provide granular overviews of exactly which activities credentialing staff have taken in the system. This allows administrators to measure productivity and ensure complete compliance throughout every phase of the credentialing lifecycle.

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CAREreport

CAREreport

CAREreport’s design reflects our philosophy that the credentialing lifecycle should exist within the context of your health system’s overall revenue cycle. With our comprehensive provider credentialing software solution, we aim to provide administrators with valuable operational, financial, and benchmarking data, empowering them with a fuller understanding of how their credentialing department’s performance is making a financial impact.

To this end, we’ve created a benchmark, comparable to Days in A/R, for both delegated and non-delegated plans: Days In Enrollment (DIE). This innovation allows administrators to assess their department’s performance using a single metric.

Below are some of the key functions of CAREreport:

Summary Dashboards: Institutional, By Facility, Departmental, By Provider

CAREreport’s various Summary Dashboards generate executive summary reports at the institutional (or global), individual facility, and departmental levels. These dashboards depict your organization’s current enrollment status (Par, Non-Par, In-Process) as well as the financial impact of your in-process applications. Using this functionality, you can identify top in-process departments and payers, and link provider charge data to each in-process application.

Trending Dashboards: Institutional, By Facility, Departmental

With this functionality, you can track and categorize current enrollment statuses over time.

Days In Enrollment (DIE) Dashboard

DIE is a proprietary, innovative metric for trending processing times for both delegated and non-delegated payers. Similar to Days In A/R reporting, DIE reporting allows you to set institutional, departmental, provider, and payer benchmarks for the purposes of performance tracking.

Department Summary

Access breakouts of provider-based enrollment and charge data using this functionality. This feature is especially useful for revenue managers in multiple departments looking to measure specific Key Performance Indicators (KPIs).

Department Detail

Access breakouts of payer-based enrollment and charge data using this functionality. This feature is especially useful for revenue managers in multiple departments looking to measure specific Key Performance Indicators (KPIs).

Payer Dashboard

Access breakouts of payer-specific data for all institution-wide payers using this functionality. Categorize these breakouts by various criteria: delegated and non-delegated payers, in-process enrollments by payer, in-process charges by payer, etc.

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CAREbi

CAREbi

CAREbi is an advanced business intelligence tool that allows users to query any field within the CARE physician credentialing software.

Below are some of the key functions of CAREbi:

Click, Drag, and Drop Reporting

Creating a custom report is as simple as clicking on a data element in the data dictionary, dragging the data element to the spreadsheet, and dropping the data element into a customizable format.

Easy Data Manipulation and Graphic Creation

Easily manipulate data and translate it into different formats (spreadsheet, graphics, etc.).

Create Reusable Reports

Develop, templatize, and store your most frequently used reports so they can be run on demand.

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CAREqa

CAREqa

CAREqa allows administrators to automate the process of performing quality assurance reviews of their staff’s work. Administrators can perform weekly, monthly, quarterly, and annual assessments. They can also easily drill down through thousands of representative activities to identify individual tasks. Finally, CAREqa integrates seamlessly with the CARE provider credentialing software, with Quality Review documents accessible from CARE’s “Resources” tab.

Below are some of the key functions of CAREqa:

Quality Review Aging

Review your representative’s weekly, monthly, quarterly, or annual activities by account.

Drill-Down Functionality

Drill down through thousands of data points to hone in on a single activity with a few clicks of the mouse.

Online Quality Review Documents

Connect to the CARE cloud credentialing software’s online Quality Review Process and Procedures and Quality Review Forms. With CAREqa, administrators can print individual Quality Review Forms from within CARE, perform quality reviews, then go over these performance measures with staff members, providing them with immediate feedback and identifying areas in need of improvement.

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CAREdelegation

CAREdelegation

CAREdelegation allows users to create and populate delegated credentialing rosters. These rosters are also customizable, allowing your health system to meet each insurance payer’s delegated credentialing roster requirements.

Below are some of the key functions of CAREdelegation:

  • Rosters can be auto-populated with all payer-specific required data elements
  • Rosters can be created quickly using click, drag, and drop functionality.
  • Rosters can be stored for repeated use and on-demand retrieval.

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CAREexchange

CAREexchange

CAREexchange is a natural extension of the CARE cloud credentialing software, allowing users to request, age, and receive credentialing data within the cloud. Utilizing shared work lists, users can request data from a provider, track how long the request has been outstanding, and mark the request as completed once the data has been received.

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CAREscan

CAREscan

CAREscan allows user to easily scan and store primary source documents in the cloud, CAREscan further enhances the CARE provider credentialing software by auto-populating applications and/or forms with information drawn directly from relevant fields in the CARE database.

Below are some of the key functions of CAREscan:

  • Scan, store, and encrypt all documents in the cloud, providing 24/7/365 access to key stakeholders within your organization.
  • Auto-populate applications directly from CARE by quickly and easily mapping specific elements within the database to relevant fields on the credentialing application.

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CAREmail

CAREmail

CAREmail allows users to send confidential physician credentialing information via encrypted email.

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CAREresource

CAREresource

CAREresource enables representatives and administrators to access important credentialing resources online, including organizational policies and procedures, Situation Response Guidelines (SRGs), and industry information such as payer websites, specialty board websites, etc. CAREresource effectively collocates and centralizes this supporting documentation within the CARE medical credentialing software.

Below are some of the key functions of CAREresource:

Customizable Storage Options

Customize document storage locations, policies, etc., based on your specific organizational requirements.

Policies and Procedures

Securely store all relevant organizational policies and procedures online.

Situation Response Guidelines (SRGs)

Securely store all your organization’s SRG documentation online.

Online Resources

Easily access industry information from payers, specialty boards, trade publications and periodicals, etc., via embedded links to third-party websites.

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CAREportal

CAREportal

CAREportal leverages the full power of the CARE cloud credentialing software, allowing providers to enter their data remotely and from any location where they have access to the internet. Using a secure link, providers can easily enter all demographic and primary source documentation to the CARE database. Once submitted, the data is stored in a holding queue until it can be reviewed and approved for CARE ingestion.

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CAREschedule

CAREschedule

CAREschedule equips healthcare administrators and point of service schedulers with the tools they need to verify that a provider is participating in a patient’s health insurance network. CAREschedule provides real-time credentialing and enrollment validation at the point of scheduling, resulting in a better care experience as well as fewer out-of-network denials for your organization.

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CAREcvo

CAREcvo

CAREcvo grants healthcare administrators access to automated Primary Source Verification (PSV) services that meet both The Joint Commission (TJC) and National Committee for Quality Assurance (NCQA) standards. In combination with the intuitive and customizable CARElist workflow tool, CAREcvo allows you to design a PSV process that meets your organizational needs, including one that features both automated functions and tasks that must be executed manually.

Below are some of the key functions of the CAREcvo extension to the CARE physician credentialing software:

CVO Work Lists

CAREcvo allows administrators to create and customize CVO and PSV work lists that reflect their unique organizational requirements. Features include:

  • Custom Process Steps: Create custom rules and workflows around any step within the CVO and/or PSV lifecycle. Users can also easily track, trend, and report on these process steps.
  • Intuitive Load Balancing: Ensure consistent workload optimization for each Credentialing Specialist by assigning individual users to a provider’s PSV profile either manually or automatically.
  • Reassignment: Shift tasks to other Credentialing Specialists at any stage of the CVO and PSV lifecycle.
  • “Out-of-Office” Scheduling: Mark Credentialing Specialists as “out of office” so that new tasks are not assigned to their queue but only to those Credentialing Specialists who are marked as “in office.”
  • Self-Initiation: Allow providers to securely “self-initiate” the CVO and PSV processes both remotely and from within your organization.

CVO Dashboards and Reporting

CVOdashboards gives administrators the ability to view and manage CVO/PSV performance in real time. Using pre-formatted, cloud-based dashboards as well as highly granular, custom reports, you can query any data field stored within your production database. The benefits of this extension to CARE physician credentialing software include:

  • Gain additional visibility into where providers are within the PSV lifecycle.
  • Create custom metrics to benchmark organizational performance.
  • Identify which Credentialing Specialists are assigned to which providers and quickly rebalance their workloads using CAREcvo’s granular task reassignment functionality.
  • Create custom reports from any CARE filed using simple click, drag, and drop functionality.
  • Use your customizable Report Library to create, store, and access hundreds of preformatted reports.
  • Import and export data from Microsoft Word, Excel, CSV, or PDF files.

CAREpsv

CAREpsv allows users to accelerate and ensure the compliance of key primary source verification processes via automated queries of hundreds of PSV data sources. The benefits of this extension to CARE provider credentialing software include:

  • Seamless, real-time integration with hundreds of PSV data sources, including:
    • American Medical Association (AMA)
    • American Osteopathic Association (AOA)
    • Drug Enforcement Agency (DEA)
    • Federation of State Medical Boards (FSMB)
    • National Provider Database (NPDB)
  • Automated cloud-based verification: Using CAREpsv’s automated, real-time verification tools, CAREpsv will reach out to the PSV data source, submit the query, and pull a copy of the primary source verification to store in CAREdemographics. All primary source documents may be stored at the Institution, Facility, and Provider levels and easily retrieved via secure and encrypted access. Because CAREpsv is cloud-based, new primary source verification sources may be easily added as regulatory changes require.
  • Support for manual primary source verification processes as needed, and for the following PSV sources:
  • Background Checks
  • Work History
  • Peer References
  • Hospital Affiliations
  • Education History and Gaps
  • Professional Liability Coverage
  • Custom PSV Sources based on Institutional Criteria
  • Custom PSV steps that accurately reflect your organization’s processes and procedures
  • Custom timetables to facilitate continuous monitoring of the PSV data sources (e.g., TJC and NCQA) most critical to compliance with your organizational requirements
  • Historical tracking of all PSV activity by Credentialing Specialist and Provider
  • “Tickle timeframes” that allow administrators to set follow-up dates and generate system reminders regarding any incomplete and outstanding tasks (requires CARElist)

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CAREperf

CAREperf

CAREperf is an extension of the CARE medical credentialing software that allows you to facilitate data entry by designating a special class of CARE users. System activity by these data entry users will not impact your current production data and must undergo comprehensive, multi-level data review and approval processes. Administrators can also route any incomplete or invalid data back to individual CAREperf users for corrections. Only after it has been reviewed and approved will the data enter the production database and appear as part of the provider’s official dataset. Finally, all data entered via CAREperf is reportable, allowing administrators to guarantee that SLAs are met and to measure staff performance.

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Newport Credentialing