Background
The Physician Service Division of a major integrated health enterprise wanted to improve its physician credentialing workflow.  We built a custom web application to manage the entire process and their return on investment has been phenomenal.   It is a classic example of how technology that is integrated appropriately can really save time and money.  Read more about how the division now has the tools to automate their workflow via a new web application and electronic forms.

The physician credentialing workflow of this Physician Service Division, which is comprised of 20 hospitals and over 400 clinical locations, involved submission of required paper applications (as many as 65) for each payer so the physicians could be reimbursed for services rendered to patients.  The process was burdened by paper.  Providers weren’t getting applications completed in time for enrollment/re-enrollment.  In most cases, the turnaround time was one month.  Managing multitudes of faxes and scanning documents from an average of 100 providers per month created an inefficient and frustrating environment for coordinators.  On average, it took three hours to complete an application packet for a single physician and each physician must re-enroll every two years.  It could take up to 120 days to get the required paperwork submitted to the payer.  In the meantime, billing for that physician could not occur.  This created a backlog of bills, negatively affecting the hospital’s account receivable.  Worse yet, some of the payers do not accept retroactive filing for billing reimbursement, so some of the services resulted in write-offs.  This Physician Service Division spent a year investigating a number of electronic document solutions and chose the Evolution solution from Access eForms and Logical Progression.

The Challenge
There were a number of challenges that the chosen solution needed to address:

• The client used Apogee’s MSOW product for managing physician data so it had to integrate seamlessly to avoid redundance
• Create a secure, web-based provider super form that included questions from all applications and custom validation to ensure all questions were answered before submittal
• Allow the questions to be configurable in case they changed or additional applications were added in the future
• Give the Physician Credentialing Department the tools to manage the process to completion
• Generate email reminders to providers who haven’t completed the necessary forms in a timely manner
• Generate the required payer application and signature packets with super form answers merged

The Solution
Logical Progression designed a web application to manage the entire physician provider enrollment process.  Coordinators can now quickly search the provider database and start the enrollment process with the click of a button.  An email is automatically generated and sent to the provider with instructions about how to log into the site and complete the application super form.  

Coordinators Can Quickly Search For  a Provider to Start Enrollment/Re-Enrollment

The solution had to be compatible with all browsers including Internet Explorer, Safari and Firefox.  The site supports both an Intranet portal for employees, as well as a secure public portal for providers.

Using the integrated Worklist, coordinators can quickly work with queues of enrollment applications to ensure they are completed by specified anniversary dates.  They can view the provider’s progress on the super form, as well as check a detailed audit trail.  A reminder service sends out an email if the provider hasn’t completed the super form by a certain date.

Providers Monitor the Entire Credentialing Process Via Worklist

The provider is given a simple super form with a list of questions to complete.  A progress bar in the upper right of the screen tracks progress and prevents submission of an incomplete form.   If the provider is re-enrolling, the super form is pre-populated with the answers from the previous form.  Upon submission, the provider must electronically sign the attestation that all answers are accurate.

Provider Super Form

Once the super form has been completed, the coordinator can generate the necessary application and signature pages for the provider’s payer/state with the Packet Wizard.  Access PFS automatically generates the form packets and emails a PDF of the signature pages to the provider.  After getting the necessary signatures, the complete packet is sent to the payer and the process is complete.

Application Packet Wizard

Results/Benefits
The new credentialing solution has dramatically improved the healthcare enterprise's bottom line.  Here is a summary of the benefits:

• The Physician Services Division has saved time and money.
• The entire enrollment process has been reduced from 120 days to a few weeks and the hospital no longer has to worry about lost revenue.
• A process that used to take three hours per provider to generate the necessary paperwork is now reduced to a matter of minutes;Physicians are automatically notified via email when they must re-enroll.
• Coordinators no longer have to worry about submitting the correct forms to the payers.
• Physicians can easily complete an online super form and it automatically generates as many as 65 applications; this is much more streamlined and secure than faxing in paper forms.

Technology
The Physician Provider Enrollment web solution utilizes the following technologies:

• Microsoft .NET 3.5 Framework
  

• ASP.NET 2.0 web application

• SQL Server 2005 Standard database

• Internet Explorer, Safari and Firefox browsers

• Access PFS™

• Apogee MSOW™

About Logical Progression
Logical Progression is a software company specializing in elevating the visitor experience.  With over 20 years of experience, Logical Progression is an innovator in the healthcare tablet documentation market, building ink-friendly and intuitive user experiences.  Logical Ink®, the company’s core product, is a tablet-based charting solution used in hospitals and clinical trials.  The company also produces VisitTrax™, an enterprise visitor management solution. The company is based in Cary, NC. For more information, visit www.logicalpro.com.