Why delegated credentialing is such a challenge

by Jake Tunney, Product Manager, Leap Orbit

Rosters taking 45 days to upload?  Changes you submitted last year, are still being “worked?”  There are a number of problems providers face when trying to get their data updated on plans’ directories.  Let’s try to find out.  Where do these rosters go?

Well, we know they start on websites like this, asking for either ProView or an email submission with their roster template:

Only about one-third of provider groups use CAQH ProView for Groups, so many have to submit via email or SFTP.  This is the first red flag that this is an outdated process. 

If you read the fine print, this plan asks for an update every 90 days and to allow for at least 30 days for changes to be made on their side. 

This is technically a No Surprises Act violation by the plan as all provider updates now need to be processed in 2 days.

Now let’s look behind the scenes at what a plan’s process looks like:

This is an actual health plan’s roster submission process. If you’ll notice, after the data is taken in via SFTP (a seriously outdated technology) the data has to pass through 5 steps and 3 individuals’ custom processes before an error report is generated in Tableau and the process repeats itself.  Once the roster is “clean,” then it is submitted to the claims system and directory.  A number of things have to go right for provider data to be updated.  

1. Providers need to submit accurate data
2. Custom SFTP/Lambada function/Redshift/OwlDQ/Tableau processes need to work
3. The plan needs to communicate its data requirements clearly
4. The downstream system requirements have to remain the same
5. Account managers need to be able to use Tableau and collaborate with providers
6. Providers or likely practice managers need to be available to resolve issues
7. Practice managers need to have access to correct information

The crazy part about this is this happens to be a “good” process. This is a classic case of healthcare being at least a decade behind current technology best practices. 

Between the overly complex process and a “user-unfriendly” experience for providers, it’s no surprise that providers are frustrated with these delegated credentialing processes.  

That’s why I’m proposing introducing a new, modern approach that is consistent between industries.  Introducing, Convergent’s Delegated Roster Upload Tool.

Your provider groups will love our simple delegated roster upload tool – and you will too!

• Modern upload user interface
• Instant data feedback for submitters
• Stop bad data at the door
• Create custom templates on the fly
• Seamlessly integrate with your current architecture

We’re reducing data upload time by 96% while improving directory accuracy by up to 97%.  And all while using simple, modern technology that’s been adopted a million times over by other industries.  If you’d like to learn more, let’s hop on a call for a short demo by clicking here or click here to try it out.