Navigating Enrollment Requirements of a Group Merger with CredentialMyDoc

About the Customer

Tennessee Orthopaedic Clinics (TOC) has over 20 years of experience providing comprehensive medical and surgical treatment of bone, joint, and soft tissue disorders. After becoming a member of the Tennessee Orthopaedic Alliance and merging with two other organizations, they needed to find a way to get all their providers loaded onto the same contracts, under the same Tax ID, without interfering with patient care. They decided to implement CredentialMyDoc to empower them to work better as a team.

Overview

Tennessee Orthopaedic Clinics (TOC), a division of the Tennessee Orthopaedic Alliance, offers comprehensive medical and surgical treatments of bone, joint and soft tissue disorders. With over 20 years of service, they are committed to providing compassionate, specialized, and prompt treatment to all they serve.

Before TOC merged and became a part of the Tennessee Orthopaedic Alliance, the organization had nine locations serving Knoxville, Lenoir City, Oak Ridge, Sevierville, and surrounding communities and credentialed 80 Physical Therapy, MRI & CT, and Quick Care Ortho providers.

TOC was looking to partner with like-minded organizations to foster better patient care. The desire was to share best practices, technological improvements, and clinical outcome data. After rigorous research, TOC merged with two other organizations, Tennessee Orthopaedic Alliance and Mid-Tennessee Bone & Joint Clinic (MTB&J). The partnership increased their area of service tremendously

Key Challenges

The three merging organizations needed to find a way to get all their providers loaded onto the same contracts, under the same Tax ID, without interfering with patient care.

Non-centralized Credentialing:
Once merged, all three organizations had their own scheduling, pre-certification, Verification of Identity (VOI), credentialing, billing, and accounts receivable departments. Although they were merged and working together, they had three different stories for every facet of business.

Mismatched Processes:
While TOC had been utilizing an electronic platform for credentialing since 2014, one practice they merged with was on a different platform, and the other was still using a paper process. They needed to converge.

Troublesome Claims:
Because contract loads were all in varying levels of completion, this meant some claims went through, others were held, and the rest were denied. In other cases, payers kept requesting that claims be resubmitted again and again. This inefficiency needed to be tackled.

Solution Selection Process

TOC knew that for all three divisions to work seamlessly together, they needed a platform that would empower them to work better as a team. Six months into the merger, the three divisions decided to centralize their processes. They chose CredentialMyDoc for its:

Centralized Data & Documents:
Store, protect, and share information and documents for providers, locations, and Tax IDs.

Electronic Onboarding App & Provider Portal:
Interface with providers through a secure provider portal to exchange information and forms with DocuSign technology.

Auto-populate Forms & Applications:
Rapidly complete applications utilizing a library of 7,000+ preformatted payer and facility applications.

Workflow Tools:
Use pre-defined tasks to create repeatable templates for workflow, email responses, and other standardized content to reduce manual entry.

Expirables Management:
Receive weekly reminders to track expirations in a timely fashion.

Custom and Canned Reports:
Utilize dozens of pre-built and custom reports.

Implementation Tips

Garnet Health took a phased approach towards implementation and had participation from every role within its medical system that would be utilizing CredentialStream workflows to help with the rollout. Their implementation was completed entirely via remote work, due to the COVID-19 pandemic.

Major Takeaways

• Build a team committed to the implementation.
• Start early and gather all information in one place to facilitate and expedite data transfer.
• Build and/or review every provider so that files are complete for implementation.
• Define who is handling what aspect of the process, to ensure accountability during all steps of the implementation.
• Have a system in place to receive and keep up with requests to prevent any errors down the line.

Results

Standardized Privileges
Garnet Health was able to fully standardize its privileges with CredentialStream’s library of best-practice privilege forms. Providers can now request and track privileges granted online via one source.

Easier Provider Document Management
Providers can complete applications and request privileges online, giving them more time to spend with patients and less time on paperwork.

Increased Staff Productivity Levels
With less time spent working through a hybrid system and working manual processes, medical staff is able to accomplish more in a shorter amount of time.

Faster Processing
With CredentialStream in place, Garnet Health spent less time on data entry and management, and less time manually retrieving verifications. This led to a reduction in appointment turnaround.
 

Looking Ahead

With a centralized system in place, TOC can focus on continuing to grow without negatively impacting the level of care they provide.