A multi-specialty facility overcame the internal credentialing software issues and successfully submitted 150+ applications

The Client:

A large-sized multi-specialty medical practice in the U.S.

Challenges Faced:

• Unable to add manage all the provider applications and/or each payer/provider status
• Problems in maintaining the appropriate step in the credentialing processes
• Credentialing process was time-consuming
• No credentialing software to help manage or provide the visibility required
• Denials due to “out of network” were rapidly rising
• Providers felt like the company was letting them down with credentialing services

Plutus Health's Plan:

Plutus Health's credentialing experts started the project with root cause analysis of the problems. We had a brief discussion with the client and detected the following problems.

Problems Detected:

Steps followed by Plutus Health/Solution provided:

• Plutus Health’s experts detected the reason for all the problems and started working on delivering solutions to overcome each one.
• Plutus Health immediately set up a team of developers and designers to provide support.
• With the help of the latest technologies, Plutus Health added new features and made the application more performant and easier to use.

Results:

• The client was satisfied with how quickly the Credentialing situation was turned around and now their providers are “in-network”.
• Credentialing related claims denials were dramatically reduced.
• Physicians are now able to see more patients with the Health Insurance companies that they are on par with.
• Patients are happier because they are now receiving their “in-network” insurance benefits.
• Successfully submitted 150+ credentialing applications.
• All providers are now “in-network” with their region’s main insurance companies
• Provider, employee, and Patient satisfaction has increased tremendously.
• Faster turnaround times with insurance reimbursements