The following case study is an example of a ProviderTrust customer who came to us looking for support in finding more accurate results for their exclusion and license monitoring processes. The healthcare organization had previously used a vendor that returned numerous false-positives or potential matches that required additional review time and the potential for ineligible providers. Some excluded providers and vendors were overlooked entirely, exposing them to undue risk for fines and penalties.
Take a look at some of the challenges this health system faced, and how our solutions have helped automate and optimize their internal workflows and provided clarity in their automated exclusion and sanction screening.
Health System Profile
This customer is a large behavioral health organization with multiple facilities throughout 6 states. Available programs from this customer involve community-based treatment, acute in-patient settings for mental health emergencies, crisis urgent care centers, long term recovery, and more.
This customer is required to manage primary source verification for around 2,000 licensed providers, 3,000 employees, and vendor compliance for a population of around 3,000.
The Challenge
The customer was looking to reduce the administrative burden of having to do excess work in regards to resolving many potential matches or inconclusive data returned back from a previous exclusion monitoring vendor. Many times, information returned back to the customer was confusing, outdated, or unmanageable. As we began our partnership, it was clear that the most value we could add was minimizing friction for primary source verification and mitigating risk with our exact match notification system. The customer expressed that some excluded providers had even been overlooked by their previous vendor.
Because of the nature of the facilities and with many vendors contracted to perform services, it was essential for their compliance team to identify any critical concerns they were exposed to by employing or working with excluded individuals and/or entities.
Visibility at a corporate and facility level was crucial for each administrator to address concerns and communicate with their teams. The customer was looking for a healthcare compliance solution that could be configured to their needs with an exceptional level of detail and functionality.
Partnership Goals
- Establish trust with an exact match solution that is reliable and identifies areas of risk and concern
- Reduce additional verification or false-positives for excluded or sanctioned providers or vendors
- An intuitive platform that can be easily adopted by team members and utilized by administrators to see results at a high level
- Centralize provider data and ongoing monitoring records in one platform
- Create an easy way to store and manage primary source verification for their credentialing process
- Monitor healthcare providers, vendors, and third parties for any exclusions or sanctions from HHS OIG, SAM.gov, or state Medicaid authorities
- Simplify ongoing licensing board monitoring for any disciplinary or administrative actions or sanctions against providers or licenses
- Optimize team workflows with aligned policies, controlled processes, and increased accountability
- Customize business rules to support their organizational structure
- Create dashboard views to meet compliance and reporting requirements for each facility
ProviderTrust’s Commitment to Smarter Healthcare Data
How We Helped
- Automated monthly exclusion monitoring for providers and vendors with exact match results reduced the time from alert to resolution
- In the first month of implementation, our Passport solution identified 11 excluded, sanctioned, or terminated providers and vendors in their population
- Successful onboarding and team adoption from each facility to understand how to utilize Passport features
- Reduced verification re-work and resources required to manage their credentialing and renewal process
- Identify risk in their healthcare supply chain with ongoing vendor monitoring
- Provided shared insights and transparency at the organizational and facility level
- Instant reporting options provided detailed information for smoother audits and quick lookup of provider verification and monitoring history
- Bridged the gap between HR and Compliance departments for increased communication and data visibility
Customer Review
We are so pleased with our partnership with this customer and continue to learn from their unique challenges and opportunities each day to help address the needs of so many patients. ProviderTrust aims to make their lives a little easier by providing helpful tools and customer service for increased clarity while onboarding and monitoring employees, providers, and vendors.
Our team celebrates their success in having a trustworthy process to quickly alert and align their focus if a new compliance issue arises in any of their healthcare populations.
ProviderTrust continues its mission to create smarter and safer healthcare by empowering Compliance and Human resource professionals with automated solutions that impact patient care on a daily basis.
Does Your Ongoing Monitoring Measure Up?
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