Case Study
Blue Cross and Blue Shield of Alabama: Proven Strategies for Improving Provider Credentialing Processes
With more than 3 million members, Blue Cross and Blue Shield of Alabama (BCBSAL) is the largest healthcare plan in the state. Prior to 2010, the organization performed the credentialing and re-credentialing processes manually, including the application, data verification and ongoing sanctions monitoring.
They now use the CAQH Credentialing Suite to obtain provider data, verify primary sources, monitor sanctions and streamline operations.
The Challenge
With an increased demand in attestation and re-attestation, BCBSAL explored opportunities to simplify their credentialing process through:
- Reducing the amount of outreach conducted by staff to obtain missing information and clarify ineligible responses.
- Automating the querying of registry databases during the re-attestation process.
- Conducting continuous monitoring and reporting of provider sanctions.
Assuring that they met NCQA credentialing guidelines.
The Solution
Reduced Use of Manual Applications
The BCBSAL enrollment website uses the solution as its backend processor. Providers are directed to complete and/or update their profile online with all needed data, including scanned documentation. Daily, BCBSAL receives electronic provider files, and the data automatically flows into their provider data management system (PDMS), eliminating most of the paperwork, evening out the workflow and improving the timeliness of the processes.
The Results
CAQH assisted BCBSAL in better aligning their internal resources while streamlining key processes that would help them reach their goals. After implementing The CAQH Credentialing Suite, BCBSAL achieved these results:
Significantly reduce provider outreach
Decreased sanctions research and reporting to less than one-half day
Improved primary source verification (PSV) data quality
Achieved regulatory compliance
Reduced the time-to-decision process by 60 days through automation
Automated, Standardized Data Verification
The PDMS exports a roster of providers requiring re-credentialing into the CAQH Credentialing Suite. Once completed, the solution returns the provider files to the PDMS, each with a classification noting possible irregularities. A checklist report is also imported into the PDMS, along with supporting documentation, populating the provider records with each item in the report.
Timely Monitoring of Provider Sanctions
BCBSAL network providers are now monitored continuously. The solution automatically queries more than 500 sources regularly, including state licensing boards, OPM, OIG and other federal sources, and flags all sanctioned providers on the plan roster.
Find out how better data can accelerate your credentialing cycle.
