Computerized Credentialing

Computerized Credentialing: With Sy.Med, one physician practice can process 30 MCO applications in one day instead of seven.

Fondren Orthopedic Group LLP is a comprehensive association of private orthopedic surgery practitioners in Houston, TX. Formed as a partnership in 1973, the group has more than 30 surgeons practicing in nearly 20 subspecialties.

THE PROBLEM

Like many practices, we needed a long-term, cost-effective solution to the inefficiency and delays associated with the credentialing/provider data management process. Our standard practice was to manually complete individual applications; this could require as much as two hours per application.

The provider data itself resided in various spreadsheets, word documents and databases throughout the organization. Completing credentialing paperwork for 30 providers at two hours per application meant a tremendous time commitment and loss of productivity. When that amount of time is multiplied by the number of managed care organizations (MCOs) and other entities that require this information, the number of man hours is notable.

Working manually, it would take one person seven days to complete 30 applications. Multiply that by 50 MCOs and that same person could spend 375 days completing applications. Inherent in the manual process was the likelihood of mistakes and incomplete applications, which further delay a provider's ability to see patients for an MCO. We needed to do the following:

Reduce time required to credential providers with MCOs.
Accumulate and organize all data elements required to complete applications for MCOs
Automate completion of forms required using MCO format.
Track the flow of applications once submitted.
Monitor expiration dates, alert the staff when renewals are due.
Build a resource for providing data to other departments or organizations in electronic or paper form.

THE SOLUTION

After reviewing several alternatives, including a trial with another vendor, we decided to license and install Sy.Med Development, Inc.'s OneApp PRO software. This software allows us to enter all the information necessary for credentialing into a simple user-friendly Windows database, then "link" the data onto any application or form.

Forms are scanned into the system using a standard TWAIN compatible scanner. We then "map" the data onto the forms. Once a form is mapped, it can be linked to each provider's data as often as necessary. This eliminates dependence on a third party vendor for mapping forms and maintaining data.

THE RESULTS

The software was installed at Fondren within 10 days of license agreement execution. Sy.Med provided on-site training for two days in addition to the installation. Our staff was able to complete applications automatically at the end of the first training day.

When Fondren signed its most recent payor contract, we were able to deliver 30 completed applications on the same day the contract was signed. This put the onus on the MCOs to get the verifications done. The credentials were verified and the group had provider numbers within 30 days.

Using the software, it takes us 10 to 15 minutes to process an automated application and collect the necessary documentation and attachments for its submission. As new providers join the group, they provide all the information necessary to load into the database. Once loaded, our credentialing department generates all the other applications necessary to get their provider numbers and privileges with the various MCOs and facilities. The applications can all be signed at once.

Fondren recognized other benefits of OneApp as well:

The software alerts us daily of any licenses or certifications within Fondren's parameters for expiration.
All provider data is maintained in the OneApp database, eliminating the need to maintain records in separate spreadsheets and databases. This database has become the key point of entry for any changes in provider information.
We can share database information with other departments including, human resources, billing and information technology.
Provider CVOs are updated automatically as data is changed or added in the database.

SOURCE

Karen Yates, Administrative Coordinator
Fondren Orthopedic Group, LLP
Houston, TX
karen_yates@fondren.com