Improve the End to End Provider Credentialing and Contracting Cycle Time Project Summary Carla...
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Improve the End to End Provider Improve the End to End Provider Credentialing and Contracting Credentialing and Contracting Cycle Time Cycle Time Project Summary Project Summary Carla Russell Project Champions: Colin Drozdowski and Linda Bambacus February 11, 2003
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Improve the End to End Provider Improve the End to End Provider Credentialing and Contracting Cycle TimeCredentialing and Contracting Cycle Time
Project SummaryProject Summary
Carla Russell
Project Champions: Colin Drozdowski and Linda Bambacus
February 11, 2003
Carla Russell
Project Champions: Colin Drozdowski and Linda Bambacus
February 11, 2003
22
Voiceof the
Process
Voiceof the
Process
Days from Attestation Date to Welcome Letter Sent
30 40 5020 10060 70 80 90 150110 120 130 140 160 170
180 190
Average: 75 DaysAverage: 75 Days
Range: 24-191 DaysRange: 24-191 Days
Average: 75 DaysAverage: 75 Days
Range: 24-191 DaysRange: 24-191 DaysProcess Performance:Process Performance:Process Performance:Process Performance:
HOW DO WE “CLOSE THE GAP”?HOW DO WE “CLOSE THE GAP”?
84% 84% DefectsDefects
(0.5 Sigma)(0.5 Sigma)
Voiceof the
Customer
Voiceof the
Customer
Customer Expectation:Customer Expectation:Customer Expectation:Customer Expectation: 45 Days45 Days45 Days45 Days
End to End Process PerformanceEnd to End Process PerformanceEnd to End Process PerformanceEnd to End Process Performance
33
Downstream ImpactsDownstream ImpactsDownstream ImpactsDownstream Impacts
•Claim Overpayments up to 43% (HMO)
•Claims Pend, Re-Work and Adjustments
•Recovery efforts on overpaid claims
•Unnecessary member and provider phone calls
•Corrected EOBs and Remittances generated
•Provider and member dissatisfaction
Upstream processes directly impact downstream processes!Upstream processes directly impact downstream processes!
44
New provider wants in network
Triage mails application
& agreement
Application sent to cred.
POE receives materials
Cred. committee approves or denies PNA
collates
PNA CPMF loads #
PNA HMO loads #
Welcome letter #1 mailed
Welcome letter #2 mailed
Papers scanned
Papers scanned
Archives
Agreements
>180 days elapsed
Agreement
not rcvd.
6 channels6 channels
Print CACTUS
report
Again if
>45 days
Cred. not required.
Applications
Hidden FactoriesHidden Factories
Variation Kills Efficiency! Variation Is The Enemy of Best Practices!
Manual StepsManual StepsManual StepsManual Steps
Unnecessary Unnecessary HandoffsHandoffsUnnecessary Unnecessary HandoffsHandoffs
Before Picture: “End to End” ProcessBefore Picture: “End to End” ProcessBefore Picture: “End to End” ProcessBefore Picture: “End to End” Process
55
Eliminated process step of holding contracts for 45 days PNM involved in the front end of the process! Monitoring improvement (Barrier: Impacting Provider behavior)
Shift intake of application process step to Credentialing staff Eliminates step in current process Allows Credentialing to start verification immediately
Hold contract until CAQH application complete Encourages providers to complete CAQH application Reduces time in between applications and contracts completed
Eliminated process step of holding contracts for 45 days PNM involved in the front end of the process! Monitoring improvement (Barrier: Impacting Provider behavior)
Shift intake of application process step to Credentialing staff Eliminates step in current process Allows Credentialing to start verification immediately
Hold contract until CAQH application complete Encourages providers to complete CAQH application Reduces time in between applications and contracts completed
End to End Process ImprovementsEnd to End Process ImprovementsEnd to End Process ImprovementsEnd to End Process Improvements
Improvements developed by cross functional team!Improvements developed by cross functional team!
66
Implement automated workflow via National Micrographics Systems E-Flow-(2Q 2003)
Leverage technology! Proven success of tool in Corporate Finance, Credentialing and Ancillary Network! Leverage across all Provider Management areas! Special Deals Tracking Process is Special Deals Tracking Process is
next!next!
Standardize contract ordering form across ASE!
Visibility and tracking of entire end to end process!
Improve accuracy and timeliness of handling provider files!
Centralize provider documents for 8 business areas!
Eliminate FOX PRO Tracking System and terminate expensive back-end scanning contract!
Create paperless workflow for Provider Network Management areas!
Implement automated workflow via National Micrographics Systems E-Flow-(2Q 2003)
Leverage technology! Proven success of tool in Corporate Finance, Credentialing and Ancillary Network! Leverage across all Provider Management areas! Special Deals Tracking Process is Special Deals Tracking Process is
next!next!
Standardize contract ordering form across ASE!
Visibility and tracking of entire end to end process!
Improve accuracy and timeliness of handling provider files!
Centralize provider documents for 8 business areas!
Eliminate FOX PRO Tracking System and terminate expensive back-end scanning contract!
Create paperless workflow for Provider Network Management areas!
What NMS E-Flow will do for us!What NMS E-Flow will do for us!What NMS E-Flow will do for us!What NMS E-Flow will do for us!
Leverage, Standardize, Streamline, and Centralize!
77
Cred. committee approves or denies
CAQH and
Contract Info
Collected
PNA CPMF loads info in system
PNA HMO loads info in system
Welcome letter mailed
Papers scanned
Cred area pull
app begin Cred
Contract mailed to provider
Contract received
from provider
STANDARDIZE, STREAMLINE AND SIMPLIFY!
REDUCED Agreement Ordering
10 days to 1 day
REDUCED Agreement Ordering
10 days to 1 day
REDUCED
Credentialing verification step
2 days to 0 days
REDUCED
Credentialing verification step
2 days to 0 days
REDUCED
Holding contracts
45 days to 0 days
REDUCED
Holding contracts
45 days to 0 days
Improved “End to End” Process (2Q’03)Improved “End to End” Process (2Q’03)Improved “End to End” Process (2Q’03)Improved “End to End” Process (2Q’03)
88
Financial SummaryFinancial Summary Financial SummaryFinancial Summary
Savings From Improvements Notification letters sent to providers when missing information
(*Decreased Claim Pends related to provider file timeliness by 63%)
*Eliminate .5 FTE (combined with D. Davis’s accuracy project=1 FTE) $18,415 *Claims Overpayment
+$28,438
*Subtotal $46,853
Automate/Standardize Triage agreement ordering process $40,000
Eliminate duplicate agreement orders $2,320
Automate entire end to end workflow via NMS (paperless) $72,000
Savings From Improvements Notification letters sent to providers when missing information
(*Decreased Claim Pends related to provider file timeliness by 63%)
*Eliminate .5 FTE (combined with D. Davis’s accuracy project=1 FTE) $18,415 *Claims Overpayment
+$28,438
*Subtotal $46,853
Automate/Standardize Triage agreement ordering process $40,000
Eliminate duplicate agreement orders $2,320
Automate entire end to end workflow via NMS (paperless) $72,000Total Gross Hard Dollar Savings = $161,173
NMS One-Time Implementation Costs - $87,512
Total Gross Hard Dollar Savings = $161,173
NMS One-Time Implementation Costs - $87,512
Total Net Hard Dollar Savings =$73,661Total Net Hard Dollar Savings =$73,661
Future annualized savings will be gained with NMS!
99
Process Owners continue to work with NMS on design of end to end workflow Target date for implementation- 2nd quarter 2003 Measure end to end performance via NMS
Hand-Off of New Process Ownership Process Team (PNA-PNM-Cred-Triage-TBH-Ancillary) own
process and monitor performance Established and Aligned an End to end goal for first time ever!
Started Next Project Reduce HMO claim pends due to referral and authorization
issues (Linda Bambacus and Linda Whitaker)
Process Owners continue to work with NMS on design of end to end workflow Target date for implementation- 2nd quarter 2003 Measure end to end performance via NMS
Hand-Off of New Process Ownership Process Team (PNA-PNM-Cred-Triage-TBH-Ancillary) own
process and monitor performance Established and Aligned an End to end goal for first time ever!
Started Next Project Reduce HMO claim pends due to referral and authorization
issues (Linda Bambacus and Linda Whitaker)
What’s Next ?What’s Next ?What’s Next ?What’s Next ?
Process Owner Involvement & Commitment is Key to Success!
1010
Summary & Take Aways Summary & Take Aways
• Current Processes= Significant variation & long cycle times
• Downstream Impacts: REWORK and Unnecessary contacts
• Improvements impact upstream & downstream processes
• Leverage new technology across all Provider Management areas
• Control Plan turned over to Process Owners (1/29/03)
• Target NMS implementation date 2nd quarter 2003
• Measure end to end process systematically for the first time ever!!
• Current Processes= Significant variation & long cycle times
• Downstream Impacts: REWORK and Unnecessary contacts
• Improvements impact upstream & downstream processes
• Leverage new technology across all Provider Management areas
• Control Plan turned over to Process Owners (1/29/03)
• Target NMS implementation date 2nd quarter 2003
• Measure end to end process systematically for the first time ever!!
Leverage, Standardize, Streamline, and Centralize!
1111
Cross Functional Core Team
Cathy Steeley, Jo Ellen Lumsden, Shirley Silberman, Lisa Wheeler, Tim Miller, Anne Britt, Christy Allen, Didi France, Martha Junkmann, RoseMary Stewart and Mike Barnes
Systems Support Resources
Tim Tabler, Wanda Teele, AIT resources, and NMS resources
Subject Matter Experts
Credentialing Staff, Provider Network Administration Staff, Network Consultants, Claims Processors and Dan Wise
BIG THANKS
Colin Drozdowski and Linda Bambacus for their never-ending support!
Cross Functional Core Team
Cathy Steeley, Jo Ellen Lumsden, Shirley Silberman, Lisa Wheeler, Tim Miller, Anne Britt, Christy Allen, Didi France, Martha Junkmann, RoseMary Stewart and Mike Barnes
Systems Support Resources
Tim Tabler, Wanda Teele, AIT resources, and NMS resources
Subject Matter Experts
Credentialing Staff, Provider Network Administration Staff, Network Consultants, Claims Processors and Dan Wise
BIG THANKS
Colin Drozdowski and Linda Bambacus for their never-ending support!
Cross Functional Effort!Cross Functional Effort!
Questions ?Questions ?
“Operational Excellence results in world-class quality, productivity and delivery of goods and services to customers, at prices that are competitive. In today’s marketplace where forces such as technological innovation, outsourcing, e-business and
global competition are prevalent, it is becoming increasingly important for companies to pursue operational excellence.”
“Operational Excellence results in world-class quality, productivity and delivery of goods and services to customers, at prices that are competitive. In today’s marketplace where forces such as technological innovation, outsourcing, e-business and
global competition are prevalent, it is becoming increasingly important for companies to pursue operational excellence.”
