4 ways to accelerate the credentialing process

For many MSPs, processing applications eats up much of the workday. This might be especially true in May through September, when new residents are graduating and looking for their practice home. Regardless of the season, initial applications flood our offices via software, email, fax, and, yes, even snail mail.

How do we handle the ebb and flow (mostly flow) of applicants with a constant number of staff? Happily, this is a challenge with multiple solutions. For the purpose of this article, we will focus on the MSP office with a fixed number of staff, antiquated or nonexistent software, and no hope of additional funding to meet escalating processing demands. The following are steps that might prove helpful in scaling this seemingly unclimbable mountain:

• Establish realistic turnaround times. Meet with administration and your provider enrollment folks to determine a turnaround time for new applications that is acceptable to all parties. Consult accreditation standards, medical staff bylaws, and policies and procedures (in that order) to ensure your proposed timeline fits the required parameters. Often, medical staff documents and accreditation standards are specific regarding how quickly an application must be processed. If your bylaws already outline a processing schedule, determine whether this timeline warrants revision based on current accreditation standards and internal practices.

• Weed out incomplete applications. Review applications for completion as soon as you receive them. Follow your bylaws, which likely place the burden of proof and delivery of information on the applicant. For us overachievers, this means resisting the impulse, however strong, to overextend ourselves in the service of applicant satisfaction. Many MSPs spend far too much time chasing down information that should have been provided up front.

If an application is not complete, compose a kind, helpful, instructive email to the applicant, outlining the outstanding items in a bulleted list. Send the email to the applicant, place a copy in his or her file, and move on to the next application. Document the dates on which these activities (and other key credentialing steps) occurred to demonstrate compliance with the medical staff’s established timeframes for processing and retiring applications.

• Start with verifications that yield rapid returns. Before doing anything else, perform your primary source verifications with the relevant state licensure board, Drug Enforcement Administration (DEA), Office of Inspector General (OIG), System for Award Management (SAM), American Medical Association (AMA)/American Osteopathic Association (AOA), and—provided you have the necessary release—the National Practitioner Data Bank (NPDB). These entities usually respond quickly and will alert you to any unexpected issues, such as:
  • Licensure: Are there any reprimands, expirations, or non-issuances on the applicant’s license?
  • DEA: Does the applicant’s DEA registration reflect the appropriate state? Do we need to follow up?
  • OIG/SAM: Is the applicant sanctioned, or has he or she opted out of Medicare? Will that be an issue?
  • AMA/AOA: Is all of the applicant’s education/training verified, or do I need to follow up with a particular program?
  • NPDB: Did our query produce any reports that the applicant failed to disclose on his or her application?

• Streamline time-consuming verifications. Of the standard verifications we need to perform, peer references and affiliation checks typically take the longest. To encourage speedier responses, test out the following strategies:
  • Use “time sensitive” instead of “urgent” in your email/fax subject line and your cover letter. ‘Urgent’ has been grossly overused and is often not taken seriously for these types of requests. Consider the following subjectline constructions, which alert recipients to the time-sensitive nature of your request as soon as they check their email on their computer or phone:
    • Time Sensitive Please: File scheduled for committee review on May 31, 2017
    • Time Sensitive Please: Provider needed to provide services by May 31, 2017
  • In the body of the email or letter, explain why you need the response back promptly. Being straightforward and transparent about your objectives shows recipients that you value their response and respect their time.
  • Always say “thank you,” emphasizing your appreciation of the recipient’s time and participation in the credentialing process. Showing gratitude can help build a lasting rapport with colleagues, practitioners, insurance companies, and whomever else you need to query for information.

Source: Credentialing Resource Center Journal, a publication available exclusively to Basic, Platinum, and Platinum Plus members of the Credentialing Resource Center