medical service provider must
provide their credentials to the organization for which they are
providing the service before they are eligible for full reimbursement.
The process of giving this provider information to the
is called credentialing. The
organization receiving the credentials may be a hospital, insurance
company, clinic, HMO, MCO, or any of a myriad of other healthcare
typical family practice clinic with five physicians can easily be
required to submit credentials for these five providers to as many as 40 different entities.
problem with the Credentialing process in the past has been twofold:
does the doctor keep his curriculum vitae?"
"Is it current?"
"What is the status of his CMEs?"
These are questions that cause enormous stress on the
credentialing staff. A
large portion of the credentialing staff time is spent gathering and
verifying this information.
time-waster is the process of manually transferring all the required
information from the various locations of the required information to
the paper application the CVO requires.
This can include copies of the medical license (on the doctor's
office wall), the CMEs (the doctor's education file), and personal
information (from the office personnel files).
Once located, they must all be copied, then verified that they
consider that each application is typically nine pages long.
Multiply that by the five providers in the clinic and the 40
organizations that each have their own, different application.
The amount of time and effort it takes the credentialing staff
to prepare these applications can become daunting.
on top of that the NCQA requirements that the credentialing process
must be monitored and tracked.
help providers of healthcare services better manage the credentialing
process, Wybtrak, Inc. has developed the Credentialing Software
Solution. This system
transforms this complex, burdensome problem into a timely, manageable
task. The software is
truly a unique business management tool.
entered into the Credentialing Software Solution can be reviewed and
updated on-screen, or printed to hardcopy and verified by the
credentialing specialist and the provider.
To meet NCQA requirements, the provider can initial and date
any changes or updates to their information so the appropriate data
fields may be corrected/updated.
Documents such as educational diplomas, medical licenses, DEA
licenses, pharmacy licenses, board certificates and CME certificates,
can be scanned and placed right into the physician's credentialing
record where it will be a permanent part of the record.
It can then be printed with the application form with the click
of a single button.
prepare a credentialing application form
is a simple three-step process:
that simple! Any form for any provider can be retrieved at any time.
password protected database contains:
credentialing management module facilitates the ease of tracking and
monitoring all credentialing events and expiration dates.
At a glance, one can see if the credentialing process is
progressing at a pace to satisfy NCQA’s required timelines and if not,
where the delay has occurred.
Each event is date and time stamped and are as follows: letter of
intent, application received, provider data authentication sent,
provider data authentication returned, form printed, form sent to
provider, provider signed form, received form from provider, attestation
signed, form sent to MCO, credentials pended, credentials approved, or
credentials denied. Other important date and time stamped information
can be entered in the free form notes section, such as phone
conversations with credentialing agencies.
management module includes Status Reports, CME Reports and Expiration
Flag Reports (Individual, All or Expiring Only).
The user can search for expiring contracts by individual
providers, by groups, by physician networks, by managed care plans and
by any state in which the provider is credentialed.
The number of days until credentials expiration can be preset by
the user before the search is executed, i.e. if you want to search for
expiring contracts within the next month, you simply enter the number 30
in the field provided and only those contracts expiring within the next
30 days will be found.
addition, the following expiration dates can be readily tracked and
monitored: state medical practice licenses, pharmacy licenses, DEA
licenses, board certifications, board eligibilities, board
recertifications, workers comp five-hour course, workers comp exempt
status, professional liability insurance, general liability insurance,
Medicare and Medicaid licenses.
Wybtrak's Credentialing Software Solution is a critical asset to medical service providers, credentialing verification organizations, management service organizations, managed care plans and practitioner networks.
For more information, please contact us.