Provider Credentialing

Increase data accuracy and reduce cycle time in Provider Credentialing

Provider credentialing, monitoring, and re-credentialing is an arduous ongoing process for Medicare Advantage Health Plans. CMS requires all Health Plans to keep the provider directories up to date with the real-time data and may subject the Plans to penalties, or even restriction on new enrollments if inaccuracies are found.

The Medversant and Wipro partnership is focused on delivering the industry-leading accuracy in Provider Credentialing and robust Provider Data Management thru its state of the art technology and BPO capability to meet the CMS mandated credentialing, primary source verification, sanction monitoring and re-credentialing standards for the MA Plans and remain compliant.

Solution highlights:

  1. Online credentialing and enrollment portal integrated with CAQH, to capture electronic application and supporting documents Mailroom support and data entry operations for paper forms.
  2. Streamlined provider outreach by trained Analysts to obtain completed applications and minimize non-responders.
  3. Primary source verification powered by Medversant's AutoVerify™ and Encompass™. Manual source verification conducted on all failed entries.
  4. Virtual review committee solution to facilitates medical peer review meetings remotely, providing the tools and the information necessary to render and document committee decisions.
  5. A fully automated process that finds, verifies, and updates provider information and changes from thousands of electronic source authorities. Automated alerts of State License expiry and monitoring of sanctions.
  6. Provider Data warehouse with Integration with all data sources like CAQH, DEA, Boards.
  7. Compliance with CMS, NCQA, URAC, and The Patient Protection Act regulations.

Benefits

  • End to end solution- State of the art Technology, Operations, and Compliance
  • Improved Credentialing Cycle time by 50%- 20-30 days as against an industry average of 60-90 days or more
  • Improved provider satisfaction – Easy technology interface with 100% support model
  • 100% NCQA compliance requirements met from Day 1
  • Minimal CAPEX investment, SaaS-based tiered pricing