Quality credentialing verification organizations
(CVO’s) create an environment
beyond simply generating credentialing
reports for medical providers.
A CVO with good customer service
responds quickly to questions;
has trained staff that is assigned
to a particular client; can streamline
the credentialing process; has
good technology resources; and
offers extra support, such as
internal audits and tracking license
renewals. An emphasis on customer
service means that the CVO can
supply substantive information
and support to establish a true
working relationship with a medical
organization.
There are five areas of a CVO’s
customer service to consider:
flexible credentialing processes
which can be adapted in response
to client needs; a range of quality
services; quick responses to clients;
individual support; and solid
technology practices. Although
some service points, such as a
fast response to questions, can
seem small, these areas display
the quality of the CVO, which
will define the long-term relationship
between the CVO and its clients.
Adapting credentialing services
to client needs.
CVOs should be responsive to their
clients’ needs. The CVO should
be accredited by either accrediting
organization: National Committee
for Quality Assurance (NCQA) or
the Utilization Review Accreditation
Councile (URAC) or comply with
their credentialing standards.
In addition, the CVO should add
new credentialing standards for
their clients and should also
be able to adapt their credentialing
processes by adding special criteria
or using a subset of criteria.
This flexibility includes making
recommendations to streamline
processes and working with clients
to determine what they need rather
than following a preset checklist.
Individualized support and quality
controls.
Individualized service means that
there is a dedicated representative
for each client. There should
be a known manager to handle difficult
situations and an established
route to lodge complaints. All
personnel should be trained to
perform credentialing reports
according to the accrediting organization’s
standards.
There should also be an established
quality control system and regular
internal audits for managing feedback,
rewarding good service, and evaluating
bad practice. The CVO should be
able to supply a copy of their
quality control policies and practices
documentation. If they are accredited
by NCQA or URAC, then there is
a guarantee that these practices
have been reviewed and audited
and that their service meets industry
standards.
High quality services.
Two attributes of quality work
are timeliness and thoroughness.
Good CVOs will return credentialing
reports as quick as industry norms,
meaning around 60 days for hospital
standards (JCAHO) and 30 days
for managed care standards (NCQA
and URAC). The credentialing reports
will also be complete – no missing
data or criteria and with full
supporting documentation. CVOs
should have an established maximum
number of requests they make to
organizations for information
and other avenues of finding information.
Problem files should be brought
immediately to the review committee’s
attention. All of these practices
work together to make a thorough
credentialing report.
Additionally, good CVOs offer
services such as tracking licensing
dates and requirements (expirables)
and disciplinary actions by various
organizations (surveillance);
consulting and training classes
about credentialing processes;
and support during internal audits.
Quick response to client contact.
Good CVOs respond to questions
within 24 hours. They should answer
any questions fully and as quickly
and directly as possible rather
than postponing or transferring
them.
Technology resources.
CVOs should be using the most
recent technology, such as databases,
paperless credentialing, and web
access with adequate security
and access control.
Customer service is key to creating
a good relationship between CVOs
and medical organizations. Quality
control policies, flexible credentialing
processes and criteria, quick
response time, good technology
use, and responsiveness to questions
and requests are five major areas
where a CVO develops good customer
relations. All these areas mean
the CVO is responsive – that the
CVO is paying attention to individual
customer needs and consistently
doing its best to meet them.
Physician Credentialing Solutions
is a leading provider of credentialing
verification services for hospitals,
PPOs and other health care organizations.
http://www.credsolutions.com
