Pega Provider Onboarding and Administration Solution

Improve Provider Onboarding and Administration With Pega

Healthcare payers and provider groups are challenged with high costs and long provider onboarding times due to a lack of integrated and automated processes. Organizations often rely on multiple systems and manual processes to onboard and manage providers, resulting in reduced provider satisfaction and high Center for Medicare & Medicaid Services (CMS) fines due to poor data management.

Expedite Provider Onboarding

Provider Onboarding and Administration (POA) is a digital solution that can be used by payers to efficiently manage provider enrollment and the credentialing process. Built on Pega’s Healthcare Foundation Data Model, our solution leverages Pega’s low-code platform and case management to achieve operational efficiency and improve provider satisfaction.

POA provides end-to-end provider data management that begins with the provider online application via a self-service portal and goes through credential validation, contracting, and ongoing management stages. Integrated provider source verification during the credentialing process increases throughput and reduces manual effort. Pega’s built-in analytics tools continually track deadlines and renewal requirements for various licenses, certificates, continuing medical education, and other medical requirements for ongoing management of active providers.

Additional POA features include:

  • Provider enrollment and credentialing for commercial insurance, Medicare, and Medicaid
  • Medicare and Medicaid revalidation form generation to maintain billing privileges (PECOS)
  • CAQH integration
  • NPI registrations (Type I and Type II)
  • Managed care contracting
  • Hospital privileging
  • Real-time application status dashboard
  • Supplement/source of truth for Find A Doctor
  • Breaking down siloed systems for centralized view without custom development
  • Automation of manual ad hoc processes
  • Paperless contracting and records

POA’s centralized platform for provider onboarding results in improved provider satisfaction and significantly reduces provider onboarding time from 6 – 18 months to 6 – 8 weeks.

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