19 January 2024 |
Credentialing 2.0: How a behavioral health group transformed its growth strategy by streamlining legacy credentialing through Medallion’s superior platform and process
By Blake Madden
Today we’re continuing the series on credentialing by diving into a real world example on how a good strategy and the right partner drives scalability, provider retention, and other positive effects on your organization.
To that end, I sat down with Matt Ortiz, VP of Payor Strategy & Relations at Family Care Center, a comprehensive provider of mental health services with 25+ locations across Colorado, Texas, and Tennessee, to understand their strategy around credentialing and why they ultimately chose Medallion.
Even though this post is sponsored, I’m hoping this post provides folks at provider organizations with thoughtful insights on how to think more tactically around credentialing – and how a streamlined process drives real clinical & financial results. If you have any questions for Medallion feel free to touch base with them here.
Let’s dive in!
This essay is a sponsored post in partnership with Medallion. I write these posts for companies with products or missions I believe can provide value-adds for Hospitalogy subscribers, many of whom work with/for hospitals or provider organizations that deal with issues like credentialing on a daily basis.
If you’re interested in a sponsored deep dive, please reach out to [email protected]!
Family Care Center’s Credentialing Journey: Key Takeaways
Family Care Center’s (FCC) in-house credentialing process was causing major headaches.
Their providers had to wait 90 days – up to 6 months in certain cases – to complete the credentialing process, leading to cash flow issues for FCC and frustration for providers.
Adding to this internal irritation, credentialing specialists were hard to find and retain. Turnover compounded these problems.
Partnering with Medallion cut FCC’s direct payor enrollment days in half, and with delegated credentialing, FCC is now onboarding and credentialing new providers within days of onboarding / employment.
FCC is in growth mode, entering several new markets, and Medallion’s solution helps them scale much more effectively.
Diving into the Family Care Center Growth Story
Originating in Colorado, Family Care Center (FCC) set out on a mission to do outpatient behavioral health better. Right from the onset, Matt Ortiz and the rest of the leadership believed that the right model for behavioral health was providing comprehensive mental health services in a collaborative clinic-based model.
To that end, FCC provides a comprehensive outpatient mental health service model – to include talk therapy, various forms of counseling, medication management, and transcranial magnetic stimulation (TMS for short) – within their 5,000 to 7,000 square foot clinics. Each unique clinic holds anywhere from 15-20 therapists, psychiatrists, and other licensed mental health professionals, all of whom provide both in-person and telehealth services from within the clinic walls.
Interestingly, FCC’s centers are on the larger end when it comes to mental health clinics. The setup allows for a more collaborative environment for providers, leading to great culture, lower turnover, and better patient care.
FCC’s clinic-based approach and treatment efficacy quickly gained traction, and an impressive growth story unfolded from there. Today, FCC operates 20 clinics in Colorado, 7 in Tennessee, and 4 in Texas, with more on the way. They’re also entering Arizona and Florida in 2024.
But this success story wouldn’t have been possible had FCC not done something about its festering provider credentialing problem.
FCC’s Legacy Credentialing Conundrum
With a focus on large clinics and more providers, getting therapists onboarded, credentialed, and ramped up quickly was key to FCC’s growth trajectory and financial success. Easy enough, right?
Wrong. FCC couldn’t get its providers credentialed on time.
For one, credentialing specialist roles are hard to fill, and harder to keep around. FCC struggled with hiring and rehiring quality specialists, which hamstrung FCC’s ability to get providers at new clinics credentialed and ramped up.
Second, when they did have some consistency in the role, FCC often ran into clerical and administrative errors. When doing direct payor enrollment, not all of the payor processes and forms are standardized. Small errors held up the process for months, and during that time, the therapists were working pro bono. Ultimately those submitted claims would be denied by payors for non-participation reasons, and FCC would have to write off those services rendered.
It would take FCC’s legacy credentialing process upwards of 90 to 120+ days to get one new clinician credentialed – even up to 6 months with certain payors. Think about that – that’s half a year of a therapist working for no reimbursement. It’s a huge impact on clinician morale when infuriating, avoidable administrative hurdles get in the way of patient care and running your healthcare organization well.
So, FCC was flying blind on the credentialing front, hoping the forms were getting filled out correctly and submitted on time. FCC also didn’t have the manpower or resources to follow up across the large volume of payors it worked with.
It was clear that credentialing was holding up FCC’s organizational success and clinician morale.
So, in June 2022, FCC inked a contract with Medallion to take charge of their credentialing workflow. And after seeing the results from Medallion’s actions, they couldn’t sign a multi-year extension fast enough.
Here’s what changed.
How Family Care Center Streamlined its Credentialing Process
Matt would be the first one to tell you Medallion played a pivotal role in FCC’s clinic growth and overall success.
Almost immediately after partnering with Medallion, FCC saw its direct clinician payor enrollment drop in half, from 90-120 days to 45-60 days. While this initial impact was profound, the real game changer was Medallion’s ability to pursue credentialing through delegated agreements.
Delegated agreements provided FCC with an alternative to having to individually directly enroll every new FCC clinician with every single payor.
Progress was swift. From June 2022 onward, Medallion injected a lightning rod into FCC’s credentialing process.
The first delegated agreement came through within 30 days – Tricare.
FCC secured 3 delegated agreements in 3 months, reaching 7 in total – all with national payors – in the first year of working with Medallion.
Through one platform and CAQH integration, Medallion can onboard new FCC clinicians in 2-3 days!!
And even though delegated credentialing requires annual audits by each payor, Medallion helped FCC secure a 100% auditing score across the board.
One of the final questions I posed to Matt was around the payor side of things. Sure, you can do everything you can on the Family Care Center side to get your providers credentialed, but if payors take their sweet time it doesn’t matter, right? Matt responded by saying that Medallion had the resources, experience, and personnel to proactively reach out to their payor contacts. FCC simply didn’t have the bandwidth to jump through all of those hoops.
Family Care Center’s Revamped Provider Onboarding Process
With the success of delegation, FCC was able to revamp its onboarding process to a matter of days. Matt generally described it as follows:
- Hire a new provider – offer letter signed for FCC.
- The clock starts ticking for the credentialing process.
- Provider completes a credentialing packet (that FCC’s internal team sends over.)
- FCC gets on an onboarding credentialing call with the provider to answer any questions they may have.
- FCC gets the provider set up with a Medallion profile, account, and forms for specific payor documentation requirements.
- Medallion does its magic for the monthly credentialing committee meeting.
- Delegated rosters get sent out to payors with the effective dates of the newly onboarded FCC provider.
- Provider is now credentialed basically on day 1 of service.
- FCC can bill and submit claims for reimbursement within week 1 of employment.
The Positive Externalities of a Better Credentialing Process
While every payor doesn’t yet do delegated agreements (there’s some risk involved), the new process has been a huge game changer for FCC.
Beyond just that, it’s pretty crazy to see all of the positive effects one vendor can have on an organization like FCC.
Here were a few more positive externalities Matt noted:
- Happier, retained providers: Medallion enabled FCC therapists to be credentialed from day 2-3 onward!! Matt couldn’t stress enough how big of a deal this change was for them. Ask any physician or clinician what they want to spend their time doing, and it’s NOT wasting time on administrative or clerical work. They want to onboard quickly, see patients, and get paid for doing so. Delayed credentialing is a huge pain point for providers in general, so a 2-3 day onboarding process is ideal for them. Happy provider, happy life. Isn’t that how the saying goes? You can’t really quantify a happy workforce, but there are strong positive effects of it that vibrate throughout the business. It also helps FCC with word of mouth provider recruitment in new markets.
- Stronger cash flow: Faster credentialing means a speedier path to getting paid and a diversified payor mix since, you know, they’re actually credentialed with more payors.
- Cost savings: Like I mentioned, credentialing specialists are hard to find and retain. FCC really only needs one or two internal FTEs for the whole organization now while Medallion’s platform is easy to manage and automates where it can – driving significant cost savings from lack of turnover, provider retention, and reduced administrative time for other FCC corporate employees.
- Scalability: Getting new providers onboarded so quickly leads to much more effective scalability across the organization. FCC can now enter Arizona, Florida, and future markets with confidence knowing it can credential providers in a matter of days.
Medallion did the blocking and tackling of credentialing for FCC, and it can do the same for your provider organization
After hearing Matt rave about Medallion, I hope it’s clear that their team provides clear ROI for provider organizations looking to streamline the credentialing process.
In summary, FCC chose the right partner for their credentialing needs, and Medallion can help other provider organizations with the following:
- Medallion does credentialing faster with better quality. They do the little things right, automate what they can, and get providers in-network faster.
- Quicker credentialing = faster reimbursement. Medallion’s credentialing solutions provide clear financial ROI for healthcare organizations, including better revenue cycle management and stronger relationships with payors.
- Credentialing in its current state is terrible. It’s intricate and labor-intensive.
- Payors like to take their sweet time with these types of things, which makes a bad credentialing process worse.
- Doing credentialing the wrong way creates compliance, scalability, and cash flow issues.
- Medallion is a credentials verification organization (CVO) backed by automation and expert guidance
- You can schedule time or a demo with Medallion here.
That’s it! Thanks for reading.