Report key performance indicators to leadership
Q: What are some examples of typical key performance indicators (KPI) one can report to leadership around credentialing production on a health plan/managed care perspective?
Jennifer Cloud, CPMSM, CPCS: Turnaround times are critical. Everybody wants to know: Where is the information? What’s the hang-up in the process? Being able to definitively show that is critical, but also when you're talking about primary source verification, what are the elements that are taking so long to have returns? From a managed care perspective, you may or may not be capturing references. If you’re following NCQA, probably more than likely not, but some of those folks that do have to capture that information, those are elements that may present where you can actually garner additional programs or additional support to help lower those turnaround times
Christine Bergeron: I would also add to that the external communication that you’re doing with outside sources: … Are you communicating the best way that you possibly can with your practitioner to obtain that information? Often, we see those are the biggest, longest, time periods of the process. So it is important to have the ability to really dive into that and see where those obstacles are. Can you effect change really easily for that practitioner to get you what you need, especially in this day and age where they are going to be incredibly busy? It’s going to become increasingly more difficult to get their attention.
Source: News & Analysis