- Location: Florida
- Provided: Healthcare
- Services Provided: Medical services through a network of Nurse Practitioners (NPs) and mobile imaging services.
Background
The client is a leading healthcare provider in Florida, relying on a network of Nurse Practitioners (NPs) to deliver diverse medical services. Proper credentialing of these providers is crucial for compliance, insurance reimbursements, and overall quality care delivery.
Initial Challenges
Initially, the client outsourced their NP credentialing to a company that used an automated process. While intended to streamline credentialing, this approach led to several critical issues:
- High Error Rate: The automation often resulted in errors in credentialing applications, such as incorrect or missing information.
- Time-Consuming Processes: Despite automation, the credentialing process remained slow and inefficient, causing delays in provider approvals.
- Process Mismanagement: The client struggled to maintain appropriate steps in the credentialing process, leading to confusion and inefficiencies.
- Rising Denials: There was a significant increase in denials due to providers being classified as “out of network,” adversely affecting patient care and financial performance.
- Provider Dissatisfaction: Providers felt let down by the credentialing services, leading to frustration and low morale.
Problems Analysis
Apaana Healthcare stepped in to provide comprehensive support to the mental health practice. Their approach included:
Automation Limitations:
The automated system was not equipped to handle the complexities of credentialing, resulting in frequent errors.
Lack of Quality Control
Inadequate quality control measures led to unchecked errors in credentialing applications.
Inefficient Workflow
The credentialing processes were not streamlined, causing delays and bottlenecks.
Inaccurate Network Management
Providers were often incorrectly listed as “out of network,” leading to increased denials.
Communication Issues
The automated system failed to facilitate effective communication between the credentialing company, the client, and the providers.
Transition to Apaana
To address these challenges, the client switched to Apaana, a credentialing provider renowned for its efficient and personalized approach. Apaana implemented the following solutions:
- Manual Oversight with Technological Support: Apaana combined manual review by experienced credentialing specialists with advanced technological tools to ensure accuracy.
- Streamlined Processes: Apaana introduced a streamlined credentialing process adhering to industry best practices, reducing delays and ensuring proper process management.
- Enhanced Quality Control: A robust quality control system was put in place, reviewing applications at multiple stages to significantly reduce errors.
- Accurate Network Coordination: Apaana worked closely with the client to ensure accurate network listings, reducing “out of network” denials.
- Improved Communication Channels: Regular updates and clear communication were established between Apaana, the client, and the providers, promptly addressing issues and maintaining satisfaction.
Outcomes
The transition to Apaana led to several positive outcomes for the client:
- Reduced Errors: The error rate in credentialing applications dropped significantly, leading to smoother processing and fewer resubmissions.
- Faster Credentialing: The time required to complete the credentialing process was greatly reduced, allowing providers to begin their practice more quickly.
- Enhanced Compliance: The client maintained appropriate steps in the credentialing process, ensuring compliance with regulatory requirements.
- Fewer Denials: The number of denials due to “out of network” status decreased dramatically, improving patient satisfaction and financial performance.
- Provider Satisfaction: Providers reported higher satisfaction with the credentialing process, feeling more supported and valued by the company.
Expansion and Continued Partnership
Impressed by Apaana’s services, the client decided to expand their partnership. Apaana helped the client establish a new practice to offer mobile imaging services in Florida. Recognizing the quality and efficiency of Apaana’s credentialing services, the client awarded them the work order for credentialing and licensing for the new mobile imaging practice.
Conclusion
This case study demonstrates the transformative impact of Apaana’s credentialing services on a Florida-based healthcare provider. By addressing the limitations of the previous automated system and implementing a balanced approach combining manual oversight and technological support, Apaana helped the client overcome their credentialing challenges. The result was improved accuracy, faster processing times, reduced denials, and enhanced provider satisfaction. The continued partnership and expansion into mobile imaging services highlight the client’s trust and satisfaction with Apaana’s exceptional services.
