Provider Lifecycle Management: What is it and how does it affect Credentialing?

If you have been in credentialing for as long as I have, you may recall the “Good ol’ days.”  The days when you could reach out to and actually speak to a health insurance credentialing specialist or contract manager directly.  Today, we have all of these various payor portals to deal with-UHC, Optum, Availity, Cigna, Molina, Horizon, MultiPlan (now Claritev), Oscar – the list goes on and on. Why has an already frustrating process, become more complicated?  Is it so that the insurance payors can save money?  Is it so the payor representatives don’t have to deal with credentialing staff members’ irritation and frustration with the tediousness of the credentialing process or with what seems like incompetence of the payor processes? 

While those explanations may figure into the equation somewhat, a more realistic explanation is the health insurance companies are trying to improve how they manage Provider lifecycle management (PLM).  So, what is Provider lifecycle management and what is the purpose?   

To improve care quality and patient outcomes, collaboration between insurance payors and providers is vital.  According to HealthTech, the average hospital produces 50 petabytes of data every year or around 137 terabytes per day.  That is a large amount of data that insurance payors have to manage.  In the past, this data was maintained in multiple payor databases or systems.   

The goal of Provider lifecycle management systems is to streamline and organize provider data.  Efficient PLM systems, should consolidate all of the data that health payors collect from multiple departments and house it in one data storehouse. This approach is intended to help reduce data redundancy and eliminate errors.  

A successful PLM should provide a structure for improved provider management. A key advantage of an effective PLM would be the ability to streamline the credentialing and onboarding process. Specific advantages would include improved onboarding tracking and primary source verification processes as well as contract management.  Instead of working with several disjointed departments, onboarding professionals should benefit from more coordinated payor operations and quicker responses.   

Desired benefits or PLM Tools for credentialing and contracting should include:  

➤ Improve provider experience and responsiveness 

▪ Upload, organize, and retrieve providers’ documents. 

▪ Seamlessly request additional information requests for documents or information from providers. 

➤ Standardize the enrollment process to reduce turnaround times.

▪ Automate the credentialing verification process per state and federal standards.

▪ Streamline electronic forms and workflows for faster onboarding and improved collaboration. 

▪ Centralize committee collaboration with access to relevant information for informed decisions.

➤ Online management of your existing practice 

▪ Enable providers/practices to submit, update, and view their information via an online portal.

➤ Self-service provider data management  

▪ Maintain an organized provider directory for an improved member experience. Also, ensure compliance with marketing materials and the “No Surprises Act.” 

➤ Automated messages providing status updates 

▪ Reduce the need for onboarding staff calls and email for status updates 

▪ Provider Dashboard Notifications for updates and upcoming deadlines.

➤ Automate the contract creation process 

▪ Quickly generate standardized contracts using a contract template 

▪ Bulk contract creation to mass generate contracts for large market expansion. 

▪ Allow E-signature tools for easy review, approval, and execution of contracts 

▪ Include sample fee schedules with contract offers.

As healthcare payors introduce new technology and everchanging processes, credentialing and onboarding staff need to be constantly learning and progressive to stay on top of new developments in our field. DoctorsManagement’s credentialing staff have extensive knowledge in how to leverage current PLM platforms to ensure that our clients remain compliant with healthcare payors.  If your organization needs assistance with credentialing and onboarding, whether it be with new practice startups, existing practices adding new providers, or credentialing maintenance, DoctorsManagement is here to assist. 

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