Implementation of paperless credentialing in a multi-state managed care organization

To evaluate the impact of paperless provider credentialing in a multi-state managed care organization.

Implementation took place from June to October of 2009. A total of 6220 providers were credentialed during this study period and selected for analysis. We used an interrupted time-series design, centered the data on implementation, and then compared efficiency rates for the 14 weeks before implementation of paperless credentialing to efficiency rates for the 14 weeks after implementation.

The absence of a control group and a relatively short observation period are potential threats to validity.

The main unit of analysis was the provider credentialing file. We compared quality review pass rates, processing time (in days), and processing cost per file before and after paperless credentialing implementation.

The percentage of files passing quality review increased from 83% to 92%. The turnaround time for the credentialing process dropped from 53 calendar days to 36 calendar days.

Implementation of electronic credentialing appears to significantly improve processing efficiency. Indeed, credentialing seems to be a particularly promising area for adoption of electronic records in an administrative setting.