Cloud-Based Credentialing and Provider Enrollment Software

Use the cloud to take over your credentialing life cycle

Top

In order to help our clients pro-actively manage the increasingly complex credentialing life cycle, Newport offers the industry’s first cloud based credentialing software utilizing workflow, analytics, and business intelligence credentialing software platform; CARE. CARE enables our clients to “Take Control” of the operational and financial aspects of their credentialing life cycle by utilizing industry defining, cloud-based, revenue centric, workflow tools. An integrated credentials verification and provider enrollment platform, our clients are able to customize CARE is a cloud based credentialing software package to easily manage their entire credentialing process from electronic provider data and document management, credentials verification, provider enrollment, delegated credentialing, and credentialing edit and denials management. CARE includes:

CAREdemographics

CAREdemographics

CAREdemographics was designed with the best in breed credentialing departments in mind and intuitively reflects how best in breed credentialing departments truly operate. Below are some of the key functions of CAREdemographics:

Cloud-Based Demographic Storage

CAREdemographics enables you to store all of your key demographic data within the cloud. No longer do you need a myriad of spreadsheets and files to store all of your data. Rather, you can now store all of your applicable physician credentialing data in one, easy to use database.

Multi-Tier Database Hierarchy

CAREdemographics enables you to develop your credentialing infrastructure based on how it truly exists. 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, CAREdemographics enables you to crate your database based on how your organization truly operates.

Intuitive Database Population

CAREdemographics enables you to intuitively and easily enter data into the CARE database. Through easy to navigate tabs, you can seamlessly move from one screen to the next in a way that mirrors how credentialing should truly occur.

Mass Provider and Payer Updates

CAREdemographics allows you to update all providers and/or all payers based on one simple update. No longer do you need to update each provider and each payer individually with a new location, Tax ID, etc. Rather, you can update all of your provider’s data with one click of a button.

BACK TO TOP

CARElist

CARElist

CARElist was designed as an answer to a very simple question. Why are there workflow tools for Accounts Receivables but not for credentialing? Both are important and both affect revenue, so why doesn’t a true workflow tool for credentialing exist? The answer to that question is CARElist.

CARElist allows our clients to create task and revenue driven worklists that reflect the way credentialing truly occurs. The concept is simple: by taking all of the activities required to credential a provider and categorize them by easy to use work lists, you prevent tasks from being forgotten, improve efficiency, and reduce the time it takes to credentialing a provider. The result is increased control over your credentialing department and staff, increased productivity, and most importantly, increased revenue. Below are some of the key functions of CARElist:

Task and Revenue Driven Work List

CARElist provides task and revenue driven worklists which reflect the true steps needed to be taken in order to credential a provider.

Task Based Work Lists

Real time work lists based on the actual steps required to enroll a provider. When a particular credentialing task is conducted and completed, the user clicks ‘Complete’ on the one task which then automatically moves the task to the next work list within the Credentialing Life Cycle.

  • The creation of the next work list adds an aging date to the credentialing task and ‘Tickles Out’ the task for a particular amount of time. This process continues throughout the entire Credentialing Life Cycle until all tasks have been successfully completed and the PIN has been obtained.
  • In addition to the initial credentialing work lists, once the PIN has been obtained, additional re-credentialing, contract rate, and EFT linkage work lists may also created so as to ensure that the provider is tracked through every step of the Credentialing Life Cycle.
Revenue Based Work Lists

In addition to Task based work lists, CARElist also attaches the gross charges associated with a particular provider to the work list. By attaching gross charges and ‘tickle timeframes’ to a particular provider, the user is able to easily identify and stratify which providers have the highest revenue impact on the organization and prioritize follow up activities accordingly.

Dynamic Payer Bar

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

Tickle Timeframes

Designed to enable the user to ‘tickle out’ all applicable follow up activities, the user can conduct a follow up activity and ‘tickle out’ the account for the next time that they would like to conduct a follow up activity. Once an account has been tickled out, the account falls off of the user’s worklist, and pops up for follow up based on the chosen tickle timeframe date.

Real Time Productivity Dashboards

Designed to enable administrators to see exactly what activities their staff have taken, CARElist offers real time dashboards so that administrators can review productivity and ensure that every step taken is taken with the intent of obtaining a provider’s PIN.

BACK TO TOP

CAREreport

CAREreport

CAREreport was designed as a product of Newport’s philosophy of placing the Credentialing Life Cycle squarely within the overall Revenue Cycle. Our goal is to provide administrators with valuable operational, financial, and benchmarking data so as to gain a full understanding of how their credentialing department is performing and the financial impact of their performance. Further, our goal was to create an innovative benchmark, Days In Enrollment (DIE), just like AR days, for delegated and non-delegated plans. Newport’s innovative DIE allows administrators to easily understand their department’s performance using one metric. Below are some of the key functions of CAREreport:

Institutional Summary Dashboard

Executive Summary Report depicting your organization’s current enrollment status (Par, Non-Par, In-Process) and the financial impact of your In-Process applications. Provides top In-Process Departments and Payers and links Provider Charge Data to each In-Process application.

Institutional Trending Dashboard

Trends current enrollment statuses over time.

Days In Enrollment (DIE) Dashboard

An innovative metric to trend processing times for both Delegated and Non-Delegated Payers. Similar to Days In AR, Newport’s DIE Reports set Institutional, Departmental, Provider and Payers benchmarks from which performance is tracked and trended

Facility Summary Dashboard

Facility Based Summary Report depicting your organization’s current enrollment status (Par, Non-Par, In-Process) and the financial impact of your In-Process applications. Provides top In-Process Departments and Payers and links Provider Charge Data to each In-Process application.

Facility Trending Dashboard

Trends current enrollment statuses over time.

Department Summary Dashboard

Department Based Summary Reports depicting your department’s current enrollment status (Par, Non-Par, In-Process) and the financial impact of your In-Process applications. Provides top In-Process Providers and Payers and links Provider Charge Data to each In-Process application.

Department Trending Dashboard

Trends current enrollment statuses over time.

Department Summary

A break out of provider based enrollment and charge data. Used as a Key Performance Indicator (KPI) for revenue managers in their particular department.

Department Detail

A break out of payer based enrollment and charge data. Used as a Key Performance Indicator (KPI) for revenue managers in their particular department.

Provider Summary Dashboard

Provider Based Summary Reports depicting your provider’s current enrollment status (Par, Non-Par, In-Process) and the financial impact of your In-Process applications. Provides top In-Process Providers and Payers and links Provider Charge Data to each In-Process application. Also provides easy to identify Par, Non-Par and In-Process statuses with PINs and Effective Dates for each Plan and each Provider.

Payer Dashboard

A break out of payer specific data for all Institution wide payers. Delegated and Non-Delegated payers, In-Process Enrollments by Payer, In-Process Charges by Payer.

BACK TO TOP

CAREbi

CAREbi

CAREbi was designed as an easy to use, advanced business intelligence tool. As a result, users can query off of any field within
CARE. Below are some of the key functions of CAREbi:

Click, Drag, and Drop Reporting

Easy to use reporting which allows you to click on a data element from the data dictionary, drag the data element to the spreadsheet, and drop the data element into a customizable format. Incredibly easy to use, incredibly easy to report on.

Easy Data Manipulation and Graphic Creation

Easily manipulate data from spreadsheet format to customized graphics.

Create Re-Usable Reports

Develop and store reports that you can use on a frequent basis.

BACK TO TOP

CAREqa

CAREqa

CAREqa was designed to allow administrators to easily conduct quality assurance reviews on their staff’s work. CAREqa allows administrators to identify the work and activities that a representative has conducted based on a weekly, monthly, quarterly and annual basis. CAREqa further allows administrators to easily drill down from thousand’s of representative activities, to one activity with easy to use drill down technology. Finally, administrators can click on the Resources section of CARE and pull up a Quality Review document which they can use to easily conduct quality reviews on their representative’s work. Below are some of the key functions of CAREqa:

Quality Review Aging

Easily identify which accounts you want to review by reviewing your representative’s weekly, monthly, quarterly, or annual activities.

Drill Down Functionality

Easily drill down from thousands of activities to one activity with a few clicks of the mouse.

Online Quality Review Documents

Link up to CARE’s online Quality Review Process and Procedures as well as Quality Review Forms. Administrators can now click on the Quality Review Form, print it out, conduct quality review activities on their staff’s activities, and review the Quality Review form with their staff for immediate staff feedback and improvement.

BACK TO TOP

CAREdelegation

CAREdelegation

CAREdelegation was designed to allow users to easily create and populate payer specific delegated credentialing rosters. CAREdelegation allows you 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

BACK TO TOP

CAREexchange

CAREexchange

CAREexchange was designed to allow users to easily request, age, and receive credentialing data within the cloud. Utilizing shared work lists, users can request data from a provider, track the aging of how long the request has been outstanding, and complete the request once the data has been received.

BACK TO TOP

CAREscan

CAREscan

CAREscan was designed to allow the user to easily scan and store primary source documents in the cloud as well as to auto-populate applications and/or forms directly from the database. Below are some of the key functions of CAREscan:

  • Scan, store, and encrypt all documents in the cloud so that you have access to them 24/7/365 days a year
  • Auto-populate applications directly from the database using easy to use mapping technology. Map each data element in the database to the specific field on the credentialing application.

BACK TO TOP

CAREmail

CAREmail

Encrypted emails for sending confidential information

BACK TO TOP

CAREresource

CAREresource

CAREresource was designed to provide credentialing representatives and administrators with the ability to easily access online organizational policies and procedures, Situation Response Guidelines (SRGs), as well as industry information such as payer websites, specialty board websites, etc. Now, all organizational and industry information is available within CARE. Below are some of the key functions of CAREresource:

Customizable

Customize any document storage based on organizational requirements

Policies and Procedures

Store all organizational policies and procedures online

Situation Response Guidelines (SRGs)

Store all SRG documents online

Online Resources

Users can easily access industry information such as payer websites, specialty board websites, periodicals, etc. through the use of easy to use website links

BACK TO TOP

CAREportal

CAREportal

CAREportal was designed to enable providers to remotely enter their data from any place on earth. Using a secure link, providers are able to easily enter all demographic and primary source documentation into CARE. Once entered, the data is stored in a holding queue until reviewed and approved for entry into CARE.

BACK TO TOP

CAREschedule

CAREschedule

CAREschedule was designed to enable healthcare administrators and point of service schedulers to ensure that a provider is participating with a patient’s health insurance at the point of scheduling. CAREschedule provides real-time credentialing and enrollment validation at the point of scheduling to ensure that the provider that the patient is being scheduled with is participating with the provider’s insurance. The result is reduced up-front out of network denials for the organization.

BACK TO TOP

CAREcvo

CAREcvo

CAREcvo was designed to enable healthcare administrators to conduct automated Primary Source Verification (PSV) services according to Joint Commission (TJC) and National Committee for Quality Assurance (NCQA) standards. Using our intuitive and customizable workflow tool, CARElist, CAREcvo allows you to conduct all PSV functions in both an automated and manual process. Below are some of the functions of CAREcvo:

CVO Work Lists

CAREcvo came out of the need to develop work lists which allow users to easily customize and manage their CVO and PSV processes according to their organizational requirements. Functionality includes:

  • Ability to create custom process steps within your CVO and PSV life cycle. With CARElist, CVO users can easily create, track, trend, and report on virtually any process step within your CVO life cycle.
  • Intuitive Load Balancing – Easily assign users to a provider(s) PSV profile either manually or automatically. The result ensures that each Credentialing Specialist continually has the optimal work load based on their administrator’s discretion.
  • Re-Assign Tasks to other Credentialing Specialists within the CVO and PSV life cycle
  • Identify Credentialing Specialists as “out of office” so that new tasks are not assigned to the out of office Credentialing Specialist, but assigned to those Credentialing Specialists who are “in office.”
  • Allow providers to securely “self-initiate” the CVO and PSV process both remotely or from within your organization
  • Create custom rules and workflow around each CVO and PSV step
CVO Dashboards and Reporting

CVOdashboards came out of the need to easily view and manage CVO and PSV performance in real-time. You can easily view pre-formatted, cloud-based dashboards as well as create and report off of any data field stored within CARE. Functionality includes:

  • Quickly and easily identify where providers are within the PSV life cycle
  • Create custom metrics to benchmark organizational performance
  • Easily identify which Credentialing Specialists are assigned to which providers and quickly re-assign their work functions based on workload
  • Click, Drag, and Drop customized reporting off of any field within CARE
  • Create, store, and access hundreds of preformatted reports from your customizable Report Library
  • Easily import or export data into Microsoft Word, Excel, CSV, or PDF formats
CAREpsv

CAREpsv came out of the need for users to easily conduct automated primary source verification processes with virtually hundreds of PSV data sources. Functionality includes:

  • Seamlessly integrate with virtually hundreds of PSV data sources
  • 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 then pull and store a copy of the primary source verification into CAREdemographics. All primary source documents may be stored at the Institution, Facility, and Provider levels and easily accessed via secure and encrypted access. Because CAREpsv is cloud-based, new primary source verification sources may be easily added as regulatory changes require.
    • CAREpsv conducts, real-time, automated primary source verification with the following PSV sources:
      • AMA – American Medical Association
      • NPDB – National Provider Database
      • AOA – American Osteopathic Association
      • FSMB – Federation of State Medical Boards
      • DEA – Drug Enforcement Agency
    • CAREpsv also conducts manual primary source verification with the following PSV sources:
      • Background Checks
      • Work History
      • Peer References
      • Hospital Affiliations
      • Education History and Gaps
      • Professional Liability Coverage
      • Customized PSV Sources based on Institutional Criteria
  • Create custom PSV steps to accurately reflect your organization’s processes and procedures
  • Set up custom timetables to continuously monitor each PSV data source to meet your organizational requirements (e.g., TJC and NCQA)
  • Track the history of all PSV activity by Credentialing Specialist and Provider
  • Utilizing CARElist, set up follow up dates and “tickle timeframes” to remind you to complete any and all outstanding tasks

BACK TO TOP

CAREperf

CAREperf

CAREperf was designed to allow certain groups of users, Data Entry Users, to enter data in CARE. This information will not impact the current production data until it has gone through a comprehensive data review process which can accommodate several levels of approval. Data can also be sent back to the CAREperf user to make corrections if the reviewer(s) find any incomplete or invalid data. Once reviewed, the data will enter the production database and will appear as part of the provider’s normal dataset. All this data will be reportable to meet SLA’s and measure each group’s performance.

BACK TO TOP

Logo Header Menu