Automate your provider enrollment and credentialing services
What is Provider Enrollment?
Provider Enrollment (or Payer Enrollment) refers to the process of requesting participation in a health insurance network as a provider. Provider Enrollment for Commercial Insurance networks, involves two steps: credentialing and contracting. Credentialing
involves a detailed review of a care provider’s qualifications and career history including their education, training, residency and licenses, and specialty certificates. Contracting occurs once a provider has achieved Credentialing.
Provider Enrollment in government health programs, including Medicare and Medicaid, is a bit different. These organizations utilize PECOS (Provider Enrollment and Chain/Ownership System). PECOS enrollment allows registered users to securely and
electronically submit and manage enrollment information.
Why is Provider Enrollment important to you?
Enrolling providers is the first step in your revenue cycle. Without an efficient and effective solution in place, your revenue cycle will suffer due to claims on hold and denials. By automating and standardizing provider enrollment, you’ll get
paid faster.
With HealthStream Credentialing's provider enrollment solution, CredentialStream®, you can harness the unmatched
power of our platform, content, and data.
Platform
Content
Data
Speed Up Your Provider Enrollment Process
Only about half of the enrollment professionals we surveyed use some type of software solution to help automate their processes. Each year, we survey hundreds of enrollment professionals in our Annual Reports on Provider Enrollment to discover insights related to healthcare enrollment software. When it comes time to automate, you shouldn’t have to waste time creating new enrollment processes from scratch. With CredentialStream, you get:
- Best practice workflows and a deep library of instantly deployable content
- The ability to rapidly launch and manage best practices for provider enrollment, expirables management, data validation, integrations with other systems, online provider tools, and more
Delight Your Providers by Offering Intuitive Enrollment
The use of online tools to complete enrollment for programs such as Medicaid has increased in the past four years. When it comes time to automate, you shouldn’t have to waste time creating new enrollment processes from scratch. With CredentialStream, you get:
- Intuitively formatted privilege delineation forms with ICD-10 and CPT codes, and FPPE requirements
- The ability to rapidly launch and manage best practices for provider enrollment, expirables management, data validation, integrations with other systems, online provider tools, and more
Truly Collaborate and Go Paperless
Time is money. If you’re still using paper-based applications, performing manual verifications, stuffing letters into envelopes, and waiting on hold to follow up on an enrollment status, you’re wasting dollars. CredentialStream delivers:
- An always available one-stop shop for your team and your providers to access and share enrollment data
- A single, centralized repository where you can easily upload, store, and share as many files as you need to
Create a Single Source of Truth
As the industry continues to shine a light on patient outcomes, hospitals, medical groups, healthcare providers, patients, payers, and everyone in between, will need to collaborate and share data in new ways. With CredentialStream:
- Get up-to-date, standardized industry data tables that place all the data you need within easy reach including data from payers, hospitals, malpractice authorities, universities, state and local regulators, the DEA, and more
- Ensure your patients always receive competent care from qualified people
Report with Ease
Your enrollment solution will collect massive amounts of data. CredentialStream converts that data into graphical, easy-to-interpret, actionable insights that will reveal:
- The efficiency of your enrollment processes
- Your performance compared to those of other "like" organizations
HealthStream Credentialing currently serves over 2,400 hospitals and 1,300 outpatient facilities in the U.S. including ambulatory surgery centers, urgent cares, and medical groups. We’d like to help you automate provider and PECOS enrollment too!