Provider On-Boarding

Provider On-Boarding: Does Provider Experiences
Matter? If Yes, Let’s Talk
Session Code: WE09
Time: 10:30 a.m. – 12:00 p.m.
Total CE Credits: 1.5
Presented by: Alicia Mendez, CPCS, CPMSM
Provider On-Boarding:
Do Provider Experiences Matter? ™
By Alicia I. Mendez, CPCS, CPMSM
President & CEO
AIA Credentialing & Consulting Services
Unequivocally!
Provider Satisfaction =
1
Learning Objectives
 Illustrate why provider experiences matter to the
success of onboarding
 Identify characteristics of solutions that fail to
provide transparency & engage the provider
 Propose tools/guides to assess or improve your
processes.
Starts & Ends with us
Privileging
Provider
Enrollment
Onboarding
MSP/MSO/
MSS
What does On-boarding Mean?
Introduction/Start
40
Application
25
Credentialing – PSV/ Privileging / Membership
20
Payor Enrollment
10
Re-Credentialing
5
2
Introduction or START
• Marketing
• Campaigns
Interviews
• Dept. Chair
• CMO/Admin
Recruiters
• Pre
Application
• HR
Vetting Begins
Application
Paper
VS
Online
PSV
3
Provider Enrollment Cycle ™
How do they know???
Prepare
Application
Review/Approval
& Signature by
Provider
Payer ID &
Effective Date
Follow-up with
Payer
Send Application
to Payer
Provider Enrollment
CAQH
4
Re-Credentialing, etc…
Management of cycles
PSV – conducted by MSO/MSP/MS
Communication of PSV process
Communication of Completion (approval/denial)
Expireables
Ongoing Monitoring
What about the current
status-quo
FAILS TO ENGAGE PROVIDERS???
 Re-Credentialing/
Continued Relations
 Initial Application or Starting Point
 Provider Enrollment
 Primary Source Verification
How can we do it better?
“Let me COUNT THE WAYS”
5
Application Solutions
Solutions to PSV
PE Solutions ™
The Basics
•
•
•
•
•
•
Organization Name
Tax Identification Number
Address (complete address)
Phone & Fax
Contact Email
Contact person responsible for clarifying enrollment question
(specific to TIN/Payer assignment)
Do you utilize CAQH?
If yes, please explain how the CAQH database is utilized.
How is enrollment performed?
What software or program do you utilize to assist in the enrollment
process?
Do you have education process/policy which concurrently reviews
credentialing and enrollment updates/trends? If so, please provide.
6
PE Solutions Continued
Solutions to manage
Re-Credentialing & Ongoing Tasks
Hit “OK” to send Applications
OK
Daily Expireables
10
Overdue Expireables
1
Expireables within 30 Days
30
Expireables within 60 Days
15
Expireables within 90 Days
150
Expireables and Ongoing
Monitoring
7
Expireables and Ongoing
Monitoring
Expireables and Ongoing
Monitoring
Lets re-cap some of the tools
Establishing or Maintaining your Onboarding Process –
Checklist
PE Assessment tool
8
Selecting and leveraging
technology.
• Getting buy-in from the right mix of stakeholders is essential. All
departments that will be impacted should be consulted and/or asked to
participate.
• It’s a team effort. The right mix of people, process and tools is
essential and each organization needs to figure out what the right mix
should be for their organization.
• You can’t improve what you can’t measure. Make sure a vendor’s
solution allows you to measure and adjust processes as needed. Get
consensus on what will be measured and how results will be shared and
used.
• Resistance to change should be anticipated…...minimize resistance
by communicating why it’s needed along with specifics around how
changes will help, and how change will be managed
• Integration should be simplified. The ability to connect to other
hospital systems should not be overlooked.
Selecting and leveraging
technology (cont’d).
• Don’t shy away from leading edge solutions…..and avoid bleeding
edge technologies.
• Web technology is ubiquitous. Vendor’s solutions should be fully
web based to allow clients to leverage a solution across an organization.
Unlimited user license pricing should be part of your license agreement.
• Beware of the ‘that’s how we do it here syndrome’….. a vendor
solution should facilitate making use of industry best practices while
allowing also allowing providing flexibility for truly specific client needs.
• Would you buy a car without test driving it? Some vendors are
prepared to conduct well-defined low-cost Proof of Concepts for serious
prospects.
• Speak with vendors’ clients. They are often willing to share their
experiences…..good ones and otherwise. Some clients are even willing
to host a site visit.
Questions?
9
Feel free to REACH OUT
Alicia I. Mendez, CPCS, CPMSM
President & CEO
[email protected]
AIA Credentialing & Consulting
Services
285 Westside Avenue
Jersey City, NJ 07305
Tel: 201-435-9105
Fax: 201-435-9106
Visit us on the web
WWW.AIACCS.COM
Special Thanks
Haejune Antequera
Mike Levine
Virginia Lopez
Luis Mendez
Shirley Thompson
Hospitals, Surgery Centers, Large multi-specialty groups
MSP’s everywhere
10
Provider Enrollment Process Details Collection Form
Entity Structure Details
Organization Name
Tax Identification Number
Address (complete
address)
Phone & Fax
Contact Email
Contact person responsible for
clarifying enrollment question
(specific to TIN/Payer assignment)
If multiple TID numbers exists the above mentioned information is needed along with a copy of the
currently utilized w-9
☐Single Specialty Group
☐Entity *
☐Group Multi-Specialty Group
☐Hospital system*
☐Other ___________________________*
Kindly provide brief narrative describing entity structure, including ownership details.
You may make additional copies of this page for each respective tax if the details are different
Created by AIA Credentialing & Consulting Services
Provider Enrollment Process Details Collection Form
Department Details
# of associates dedicated
to enrollment function.
Provide titles, and if any
are certified.
How is enrollment
performed?
☐Payer is assigned to associate
☐Practitioner is assigned to associate
☐Other, Explain or provide applicable policy
Who do you perform
enrollment for?
☐Practitioners once they are approved by the BOT, and designated by policy
☐Practitioners limited to hospital/facility based clinics
☐Groups designated by the system
☐Other, Explain _________________________________________________
What software or
program do you utilize
to assist in the
enrollment process?
What “core” reporting
mechanism is utilized to
track the steps in the
enrollment process?
Define/provide core set of
reporting and or any
reporting details.
Policies and procedure,
Forms
What functions is your
department
responsible for?
Kindly provide any policy related to the enrollment process and related forms
and or visual tools utilized by the staff for processing. For example(i.e
Request for service form, enrollment policies (from notification to begin
enrollment through the obtainment of provider ID and effective date),
flowcharts, delegation, quality review prior to payer submission, etc.)
Primary source verification (credentialing) ☐initial ☐re-credentialing
Provider Enrollment ☐demographic changes ☐initial ☐re-credentialing
Maintenance of repository for ☐PSV
☐PE
☐Both
Created by AIA Credentialing & Consulting Services
Provider Enrollment Process Details Collection Form
Payer Details
List of Payers
Kindly provide list of payers which identify if the respective TID retains a group
contract (advise if delegation is an attribute of the agreement) or, individual
contract. If collection of sub product (specific payer ID) is required, sub products
must be listed on the Payer listing
Payer repository
Provide the policy or document which indicates how the payer specific details are
maintained, who is responsible for maintaining them, and how often
updates/confirmation are sought.
Payer
 What specific form (application/par form) is required by the payer?
application/Details
 What specific supporting documents are required, per payer?
 What if any specialty, allied health practitioner or ancillary service
providers are prohibited from participating in the network (closednetwork)?
Process Details
Do you have written policy and procedures that explain how the
credentialing/enrollment process is executed? If so, please provide.
☐YES ☐ NO
Do you have education process/policy which concurrently reviews credentialing and
enrollment updates/trends? If so, please provide.
☐YES ☐ NO
Do you utilize facility specific (initial & re-credentialing ) applications? If so, please
provide copies of applications, checklists, and letters utilized to solicit information or
supporting documents from the practitioner(s)?
Are you responsible for maintenance of the practitioner repository?
☐PSV
☐PE
☐Both
Do you utilize CAQH?
If yes, please explain how the CAQH database is utilized.
☐YES ☐ NO
Print Name
Person completing assessment
Created by AIA Credentialing & Consulting Services
Signature and Date
☐YES ☐ NO
☐YES ☐ NO
Provider/Practitioner On-Boarding ™
Clinical Leadership
Description/Notes
Communication with clinical leadership or their administrative staff on the required documentation

to initiate the onboarding process
Project Timeline
Start Date
End Date
Understanding, how departmental rules and regulations affect initial recruitment and vetting process
Medical Staff Office/Medical Staff Professional
Description
Project Timeline
Start Date
End Date
Develop/Maintain step by step credentialing process for applicants and or applicant's staff detailing
the onboarding process to include highlights, and timeframes leading to approval (i.e. File

processing, PSV, Chairman review and recommendation, Committee(s) and governing body
approval).
Develop/Maintain the onboarding process (Concurrently Update)
Develop/Maintain the PSV process (Concurrently Update)
Provider Enrollment
Description
Complete a PE assessment
Define Hand off (if required) between PSV completion/appointment and initiation of PE
Define reporting Structure (Standing Reports)
Define your Payer list
Determine or develop your PE approach base on PE assessment
Project Timeline
Start Date
End Date
If participating in a Delegated Agreement: Define Hand off (is required) between PSV/appointment
and Initiation of PE
Reporting Structure (Standing Reports)
Understand financial implications of payer list (who is your priority)

Recruitment
Description/Notes
Determine Utilization Parameters for recruiters to track their provider communication of prospective

providers (i.e. permission granted of updates versus view only inclusion of key stakeholders).
Development/Maintenance of Recruitment
Include key stakeholders in communication process review
Initial/Ongoing Communication with Clinical and Entity or Leadership
Maintenance of Recruitment
Marketing Material
Other
Description: Always include key stakeholders
Departmental Leads
Finance
Infection Control
Medical Records
Performance Improvement/Quality
Project Timeline
Start Date
End Date
Project Timeline
Notes