Provider Management

Credentialing

• CREDENTIALING SERVICES
• PRIVILEGE MANAGEMENT
• INTEGRATED PRACTITIONER APPLICATION
• AUTOMATED PROFESSIONAL REFERENCE
• PROVIDER DIRECTORY
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  Credentialing services centrally manage practitioner/clinician data, the practitioner application, professional references and primary source verifications for efficient evaluation and privileging. Once a digital practitioner profile is created, organizational policies are applied to render a comprehensive application report for review. In addition, integrated platform tools enable a broader view of practitioner performance to support an appointment decision including, Patient Relations, Event Management, and Peer Review.

  ALIGNMENT WITH HEALTH SYSTEM POLICIES

  Tailors information to support organizational MEC specifications for individual practitioner types and roles, including the integration of privilege specific competency requirements

  CENTRALIZED DATA REPOSITORY

  Supports the full spectrum of providers, capturing and managing data in one location, including seamless integration and cross-referencing of verification resources and sanction monitoring indices such as the NPDB, AMA, OIG and others

  PRIVILEGE SEARCH

  Search credentials via privilege type and automate external queries

  DATA VALIDATION, AVAILABILITY, AND PORTABILITY

  Available to users 24/7, providing easy access and transparency for front-line staff and leadership, and offering a portable record for providers working at multiple locations

Process Extensions

• Payer Enrollment
  Streamline the location-specific enrollment requirements that payers have established for practitioners. Separate departments within a healthcare organization typically perform enrollment and credentialing functions that certify practitioners. Beyond duplicating work, this can lead to significant liability and impose a negative impact on reimbursement. Using a shared data model, Credentialing with Payer Enrollment coordinates internal credentialing tasks and external relationship tasks. A robust tool allows users to leverage the entirety of the verified practitioner dataset, managed by Verge Health’s credentialing services, for any relationship type (payer, hospital, or licensing agency).
• Peer Review (MD/RN)
  Delivers a comprehensive process beginning with inputs from event data, patient relations, or various screening processes. Drives engagement by routing the case to stakeholders for screening, review, and approval. Dramatically decreases the time invested by practitioners and committees, quantifies data for aggregate trends, tracks follow-up activities, and integrates with the practitioner’s credentialing profile.
• Staff Credentialing
  Expand the efficient physician Credentialing process to credential additional other members of the medical staff.
• Payer Credentialing
  Connect provider data and files across payers, providers, and employers.