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

Area of Science:

• Healthcare Administration
• Health Informatics

Background:

• Provider credentialing is a critical administrative process in managed care.
• Traditional paper-based systems can be inefficient and costly.

Purpose of the Study:

• To evaluate the impact of implementing a paperless provider credentialing system.
• To assess changes in efficiency metrics following the transition to electronic credentialing.

Main Methods:

• An interrupted time-series design was employed.
• Efficiency rates (quality review pass rates, processing time, cost) were compared for 14 weeks before and after implementation.
• 6220 provider credentialing files were analyzed.

Main Results:

• Quality review pass rates improved from 83% to 92%.
• Credentialing process turnaround time decreased from 53 to 36 calendar days.
• Processing costs per file were reduced.

Conclusions:

• Paperless provider credentialing significantly enhances processing efficiency.
• Electronic records are a promising solution for administrative tasks in healthcare, particularly credentialing.