Five Ways Payers Can Improve Provider Responsiveness

By Scott Alsup

Consider partnering with a Credentials Verification Organization (CVO) to save time and expedite your provider credentialing.

It can be difficult for health plans to complete provider credentialing without the help of a CVO. As the largest CVO in the United States, Verisys can help by tracking two categories of non-responsive providers:

• PSV004 stands for Primary Source Verification 004, which means no application received.
• PSV005 translates to Primary Source Verification 005, which means no response or missing application information.

In the case of PSV004, Verisys relies on the contact information sent from the health plan to locate the provider. In the PSV005 scenario, our team tracks down the missing information. All payers that use CVOs, whether Verisys or otherwise, stand to benefit from better provider response rates. But how can you do that? Here are our top five tips:

1) Inform all stakeholders in advance. If a provider isn’t sure why they are being contacted or is unfamiliar with the CVO, they will take up your team’s time by asking for further clarification. And if your team isn’t aware of the work the CVO does for you, they will give the provider the worst possible answer: “I don’t know who Verisys is or why they are contacting you.” This results in the provider ignoring the credentialing request and being returned to you as a non-responder — the aforementioned PSV005. Some providers may even fear that the CVO is trying to steal their personal information! To ensure high response rates, reduce turnaround time, and increase provider satisfaction, take time to inform your providers and team about the credentialing process and your CVO’s role.

2) Explain the difference between credentialing and contracting. In the case of new providers, the intertwined processes can be complex and confusing. Be clear about the requirements for each to speed up applications.

3) Clean up the data. As many as 50% of entries in provider directories are inaccurate, according to Availity. And that’s just directories. Payers should either clean that up themselves or outsource the job to directory and data quality experts.

4) Drop paper for portals. Some practitioner and facility applications are submitted via paper or an electronic pdf. This method often leads to non-responsiveness and missing data, especially when compared with submissions through portals. How often? Verisys data shows a 190% increase in PSV004 (no application) and a 44% increase in PSV005 (missing information) rates for non-portal providers and facilities. Chief financial officers, take note.

5) Respond to COVID-like disruptions with agility. The average number of post-pandemic in-person visits to physician offices fell from 97 per week to 57, according to an American Medical Association survey of 3,500 physicians who provided at least 20 hours of patient care a week prior to the pandemic. Also hard hit: dental practices and nursing homes. Downstream, these drops in activity affected credentialing. Our PSV005 (no provider response or missing information) increased by 2% from 2019 to 2020. Our PSV004 (no application) jumped by a whopping 21%. In these situations, payers with in-house or CVO credentialing need to change tactics to shore up the process. For instance, post-pandemic, Verisys took the following actions:

• Made 10% more outreach attempts
• Expanded outreach teams for application-gathering, and divided associates into provider and facility specialist roles
• Enhanced the Verisys toolset to search for alternate or updated contact information
• Increased data sharing and collaboration with clients
• Improved transparency and thought leadership through additional blogging

With such significant reductions in revenue, providers and facilities must cut costs, including administrative and support staffing reductions. Full voicemail boxes, contacts no longer with organizations, and email auto-replies are increasingly common. The result: higher non-responder rates and longer turnaround times for credentialing orders.

Now more than ever, it’s important to follow best practices to improve provider responsiveness. Start with the five recommendations above, and you’ll be well on your way to saving time and money on credentialing.

Interested in learning more about Verisys’ proven approach to credentialing? Contact us today.

Scott Alsup is an experienced and enthusiastic leader, communicator, and business process improvement specialist with a proven ability to assemble and manage high-performing, customer-focused teams. As senior vice president of operations at Verisys, he directs credentialing client execution, capacity planning, and product delivery. Before joining Verisys (formerly Aperture Health), he held senior-level technology and customer service positions with Nucor, Pallas Partners, and Steel Technologies.