While many people in healthcare systems or physician practices appreciate the importance of health insurance plan credentialing, few understand the timeline and negative financial impact when the process fails. Without the proper workflow, oversight, communication and follow-up, credentialing applications can (and often do) get lost in health insurance plan “black holes”.

e4 has developed our credentialing service line to leverage decades of experience with both health insurance plans and health systems. Whether you are experiencing issues in certain credentialing aspects or need to LEAN Engineer your entire operation, e4 can provide the industry knowledge and insight you need to achieve your organizational goals.

e4’s credentialing and re-credentialing processes covers all medical providers. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans. e4 will maintain up-to-date data for each provider in credentialing databases and online systems and ensure timely renewal of licenses and certifications.

ESSENTIAL FUNCTIONS

  • Compile and maintains current and accurate data for all providers.
  • Complete provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
  • Maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  • Maintain corporate provider contract files.
  • Maintain knowledge of current health plan and agency requirements for credentialing providers.
  • Tracks license and certification expirations for all providers to ensure timely renewals. 
  • Maintain confidentiality of provider information. 

For those organizations that have an internal credentialing team, try including e4’s Productivity Tracking tool, e4sight™. This software is web-based service with minimal manual intervention. Managers and Executives can monitor their teams output compared to organization specific goals or industry benchmarks.