Provider Enrollment, Credential and Screening
Large health insurance issuers manage a few thousand to over a million providers and suppliers; and process thousands of new enrollments and reassignments each month. The provider enrollment, credentialing, and screening process is the first gate to protect bad actors from enrolling in the system and getting paid via fraudulent claims and activities. An effective provider enrollment, credentialing, and screening process should integrate data from internal and external data sources and feedback from field validators or auditors to enable identity resolution and risk scoring for the entity enrolling. eSimplicity’s team understands the provider relationship with payers, provider data, and workflow that support the provider enrollment and validation processes. Our entity-centric provider enrollment, credentialing, and screening solutions improve automation and reduce manual operation, thus lowering the burden for the good actors and preventing the bad actors from entering the system.