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Quick look: Payer organizations: Evaluating a CVO partnership

Credentialing verification organizations (CVOs) are like the secret agents of the healthcare industry.

They work behind the scenes to maintain the highest standards for health plans and payers, ensuring that only the most qualified providers become part of their networks. Use the questions below to consider whether a CVO can help your organization reach your goals faster.

Current and future provider network

  • How many healthcare providers do you currently work with?
  • How many new providers do you anticipate adding to your network in the near future?

Tip: If you work with many healthcare providers, say, hundreds or thousands, or expect significant growth in the number of providers in your network, you should consider working with a CVO.

A large number of providers can make the credentialing process time-consuming, resource-intensive, and challenging to manage in-house. Partnering with a CVO can help streamline the process, reduce administrative burdens, and maintain compliance with industry standards and regulations, ultimately leading to a more efficient and cost-effective solution.

Time and resources

  • How much time and resources are dedicated to the provider credentialing and verification process?
  • Is this impacting your ability to onboard new providers in a timely manner?

Tip: If you dedicate a significant amount of time and resources to the provider credentialing and verification process, it's a strong indicator that partnering with a CVO could be beneficial. It's especially true if you're experiencing delays in onboarding new providers or need help managing the credentialing process effectively.

Some signs that the credentialing process is consuming too much time and resources include the following:

  • Prolonged turnaround times
  • A substantial portion of the administrative staff's time spent managing credentialing tasks
  • Frequent errors, incomplete paperwork or missed regulatory requirements
  • Difficulty meeting the demands of a growing provider network

Compliance and regulatory requirements

  • How well do your current credentialing and verification processes meet compliance standards?
  • What risks does your organization face if not in compliance?

Tip: Assess your credentialing process's compliance with industry standards. Non-compliance risks include fines, penalties, reputation damage, and loss of contracts. Partnering with a CVO can minimize risks and ensure regulatory adherence, safeguarding your organization's success.

Cost comparison

  • How much are you spending on internal resources to manage the credentialing and verification process?
  • How does this compare to the cost of outsourcing to a third-party organization?

Tip: Evaluate your internal credentialing costs, including staff time, software, and overhead expenses. Compare these to the potential cost of outsourcing to a CVO. Outsourcing can often provide cost savings, better resource allocation, and improved efficiency in the long run.

In-house expertise

  • What kind of experience and expertise do you have within your organization to manage the complexities of credentialing and verification?
  • Can a third-party organization help you achieve greater efficiency and effectiveness?

Tip: Examine your organization's expertise in managing credentialing complexities. If gaps exist, a CVO partnership may boost efficiency and effectiveness by leveraging their specialized knowledge and resources, ultimately optimizing your credentialing process.

Ongoing monitoring

  • How well can you manage the ongoing monitoring of provider credentials and performance?
  • What tools or resources do you currently have in place to support this process?

Tip: Assess your ability to monitor provider credentials and performance consistently. If lacking tools or resources, consider a CVO partnership to enhance monitoring capabilities, ensuring a reliable and high-quality provider network for the long term.

Finally, ensure you determine the importance of speed and accuracy in your credentialing process. If meeting member and provider needs in a timely manner is crucial, and you feel your process could move faster, a CVO partnership can enhance efficiency, ensuring a seamless and accurate process that benefits all parties.

Successful organization use Medallion

For more comprehensive information on this topic, read CVO credentialing: The key to unlocking efficacy and lowering costs for payers

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