Roster management can be a medical providers nemesis without the proper database set-up. Monthly roster audits are seen as creating no value for the providing business and is a compliance step that payers (insurance companies) require. For a small medical provider who only has one or two clinicians in the business its not a big deal. But for the growing Telehealth industry this is truly a bottleneck for the team. I have been asked by my Telehealth client to help build a solution for credentialing and roster management. Currently it is taking one employee roughly 30-40 hours a month to complete a roster audit. That might not seem like a lot, but when you are a growing Telehealth company and expanding to different states and adding additional payer contracts this work will only increase.
Now lets break each of these problems down more.
Through my research so far roster management is evolving, although very slowly. The simple truth is that the US health industry was not prepared for the Telehealth world. Depending on which insurance payer you work with you can expect spreadsheets with 40-100 columns of information to fill in or possibly a form that you input each provider individually. Depending on what services the provider is offering and the credential that are required to complete the service, some fields are filled out, and others are left blank.
Each insurance payer has its own spreadsheet file format that it wants its providers to submit. Each payer has their own column header naming convention, order of columns, and content requests. It's not that the information is hard to obtain for the provider, its that the information is not formatted in the way the payer wants.
For example one payer may ask whether a provider is board eligible and expect responses like: "Is eligible", "Is not eligible". Another, payer might want "Yes" or "No" Responses to the same question.
This is easily solved with some IF formulas in a spreadsheet but will require some work. Now multiply this by 40 to 50 columns and you can see how the hours will add up.
CAQH is the main point of reference for gathering most information that is contained on a roster. Although with credentialing and the steps that are involved in that process most of the same info is collected initially. So dependent on how the provider is capturing and storing the credenitalling information will dictate how easily the information is available for the roster. In the current provider I am building a solution for the credentialing team works somewhat autonomous and provides updates to the roster management team member. Because credentialing can take time, the information provided at the end of the month might not be as accurate as providers may be in mid process of credentialing at the end of the month.
There are not a lot of options out there for the Telehealth organizations that could be credentialing hundreds of providers in any given month depending on if they are expanding into new states. The list of software companies providing this rapid credentialing is short and I will leave for another post. These credentialing softwares are pulling Information from the CAQH in a csv or excel format and providing to the providers. Here is another problem that is created regarding spreadsheets. This looks to the be the Practice manager module, although my current client is not using this module. Dealing with different column headers requires knowing what that header means in one requester versus another.
Would you like help with your roster management and provider credentialing?
