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Proven Strategies for Improving Provider Credentialing

Blue Cross and Blue Shield of Alabama Case Study

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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

DataSpring assisted BCBSAL in better aligning their internal resources while streamlining key processes that would help them reach their goals. After implementing The DataSpring Credentialing Suite, BCBSAL achieved these results:

providers

Significantly reduce provider outreach

verified-1

Decreased sanctions research and reporting to less that one-half day

health-plan

Improved primary source verification (PSV) data quality

government-policy

Achieved regulatory compliance

time-savings

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 DataSpring 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.

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"The data quality is very good, the processes are automated, and we've been able to reduce staff time. We now depend on DataSpring solutions to help our plan bring efficiencies to the provider credential and re-credential processes."

-BLUE CROSS AND BLUE SHIELD OF ALABAMA