US Provider Credentialing Data Management-Industry Trends

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US Provider Credentialing Data Management-Industry Trends

We located 3 clear trends concerning credentialing data management in the healthcare industry. Blockchain technology is being evaluated and included in new solutions for the industry. Several organizations and government agencies are actively implementing standards for data management. New solutions in credential data management focus on process improvement through automation and APIs.

Overview

Data management is vital for the healthcare industry, but it has been an area with some pronounced weaknesses, undermining an efficient credentialing process. According to the Council for Affordable Quality Healthcare (CAQH), “the healthcare industry experienced the most cyber-attacks of any industry in 2015, with over 100 million records compromised.” Addressing this vulnerability remains a priority and a driving force in data management trends.
The trends included in this list are data management solutions that either targeted credentialing specifically or that acted to streamline the external processes that impacted credentialing data management. The trends were sourced from healthcare data management organizations and news publications of repute.

Trend #1 Blockchain

According to HealthITAnalytics.com, 2017 saw the partnership of Hashed Health and the Illinois Blockchain Institute to evaluate the applications of blockchain technology to credentialing. The two organizations are developing the Professional Credential Exchange Tool. This provider credentialing technology will securely transmit data detailing clinician location and permitted level of practice and will facilitate credential management.
HealthStandards.com breaks down the usefulness of blockchain to credentialing data management by explaining the process. Physician information, including degrees, certifications, and licenses, would be authenticated by the primary source organization, then encrypted and placed on the blockchain. After that data is accepted and integrated on the blockchain, HealthStandard.com states, the information becomes immutable, making the Blockchain the single source of truth that can be trusted by all organizations and individuals needing validated physician information."

Trend #2 Data Standardization

There are several organizations and government entities working to establish standards for directories and their management. The activities of these organizations is just below.
- The Argonaut Project is an initiative by Health Level 7 (HL7) concerning Electronic Healthcare Records (EHRs). By establishing standards and services for EHR sharing, HL7 aims to enhance compatibility with mobile apps and web-based services.
- The New York State Department of Health instituted submission standards for provider information for their adequacy review of health plan networks.
- According to CAQH, The Centers for Medicare and Medicaid Services (CMS) created “directory requirements for Medicare Advantage, Medicaid Managed Care, and qualified health plans.” These include standards for accessibility, update frequency, and certain mandatory elements to include.
- Also according to CAQH, Medicare Advantage has standard requirements which mandate regular data verification of providers.

Trend #3 Process Improvement Through Automation and APIs

By improving processes through automation and APIs, data management is less subject to human error and the drain on resources required to repair those errors. CAQH has produced an automation solution called VeriFide that streamlines the verification process of source documents submitted by providers. It eliminates manual input from the process, increasing speed as a result. CAQH asserts that VeriFide returns 98% of submissions within 2 weeks “with 98.5% accuracy and completeness.”
PR News Wire reports that Santéch has produced an API compiles “fragmented and distributed provider data”, allowing it to be shared with multiple payers in a format ready for use in credentialing and many other purposes. This enhances the speed of the credentialing process in general by improving the efficiency of data management processes.

Conclusion

In the healthcare industry, credentialing data management has seen new technology become important as blockchain is incorporated into the industry. Other trends are process improvements through the use of APIs and automation and the implementation of standards for that data.

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