Provider Enrollment Request Cycle Time

Transcription

1 OpsDog KPI Reports Provider Enrollment Request Cycle Time Benchmarks, Definition & Measurement Details SAMPLE CONTENT & DATA 2017 Edition

2 Definition & Measurement Details What is Provider Enrollment Request Cycle Time? The average number of days required for a health insurance company, or payer, to process a request from a healthcare provider for enrollment into their provider network, from the time the request is received by the payer until the provider has been credentialed and onboarded. Why should this KPI be measured? Provider Enrollment Request Cycle Time, or turnaround time, measures the amount of time it takes for a health insurance company to enroll a new healthcare provider (i.e., doctor/practice, hospital, pharmacy, etc.) into their healthcare provider network. Extended provider enrollment cycle times can negatively impact customer service levels (where the provider is considered a customer), as well as employee productivity and capacity within the Provider Services/Network Management function. A number of avoidable issues typically extend these cycle times, including highly manual enrollment processes (e.g., a high percentage of enrollments completed on paper forms), decentralized provider data (e.g., provider data resides in different systems), and a lack of provider data standards (for both inbound data and existing provider data maintenance). How is this KPI calculated? Two numbers are used to calculate this KPI: (1) the sum of time required to complete all healthcare provider enrollments (measured from the time that the enrollment request forms are initially submitted by the provider, until the insurance company has performed all required credentialing and account onboarding processes) over a given period of time, and (2) the total number of provider enrollment requests completed over the same ABRIDGED CONTENT time period. All forms of provider enrollments - paper, electronic, etc. - should be included in this calculation. Both new provider requests and Purchase to View Full Definition & Measurement Details! existing provider re-credentialing should be included in this calculation. Do not include enrollment requests that were not approved by the insurance company in the numerator or denominator for this calculation. Related KPIs Contracted Fee Schedule Match Rate, Claims Denial Rate (Medical/ Health), Patient Eligibility Accuracy Rate, ERA Transparency Rate Formula (Sum of Provider Enrollment Request Cycle Times) / Total Number of Provider Enrollments Completed 1

3 Benchmarks & Characteristics of High Performers Provider Enrollment Request Cycle Time (Sum of Provider Enrollment Request Cycle Times) / Total Number of Provider Enrollments Completed High Performers SAMPLE CONTENT Low Performers Avg () Purchase to View Actual Benchmarking Data! Characteristics of High Performers KPIs are well-defined, tracked and tied to performance reviews Robust self-service options for customer (online FAQs, etc.) Agents cross-trained to handle and resolve multiple call types KPIs are well-defined, tracked and tied to agent performance reviews Sample Size: KPI Type: Unit: Is High or Low Best?: How to read this chart: This chart summarizes the performance gaps between high (Top 5%), mid (Median) and low (Bottom 5%) performers for this Key Performance Indicator (KPI). For example, the column labeled Top 5% represents a company that outperformed 95% of the peer group observed for this metric. 2

4 Benchmarks & Long Tail Analysis Provider Enrollment Request Cycle Time (Sum of Provider Enrollment Request Cycle Times) / Total Number of Provider Enrollments Completed SAMPLE CONTENT Purchase to View Actual Benchmarking Data! Avg () Min Top 25% Cut-off Median Bottom 25% Cut-off Max High Performers Low Performers How to read this chart: This chart plots all values within the observed population for this KPI. This chart can be useful in analyzing the upper and lower boundaries (i.e., minimum/maximum values) and the amount of the population that falls above/below the average for the KPI, among other things. 3

5 Benchmarking Report Terms & Conditions OpsDog KPI Reports 2017 OpsDog, Inc. The OpsDog KPI Reports and their contents are protected by copyright laws, contain the trademark OpsDog, Inc., and are OpsDog s proprietary information. No part of this book shall be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from OpsDog, Inc. OpsDog, Inc. assumes no liability with respect to the use of the information contained herein which is provided as is and there are no warranties of any kind provided by OpsDog with respect to this report. OpsDog assumes no responsibility for errors or omissions and will not be liable for any damages resulting from the use of the information contained herein. OpsDog, Inc Augusta Dr., Suite 200 Houston, TX Tel: