* Is High or Low Best: Lower is Better
Provider Enrollment Request Cycle Time, or turnaround time, measures the amount of time it takes for a health insurance company to enroll a new healthcare provider (i.e., doctor/practice, hospital, pharmacy, etc.) into their healthcare provider network. Extended provider enrollment cycle times can negatively impact customer service levels (where the provider is considered a customer), as well as employee productivity and capacity within the Provider Services/Network Management function. A number of avoidable issues typically extend these cycle times, including highly manual enrollment processes (e.g., a high percentage of enrollments completed on paper forms), decentralized provider data (e.g., provider data resides in different systems), and a lack of provider data standards (for both inbound data and existing provider data maintenance).
The average number of days required for a health insurance company, or payer, to process a request from a healthcare provider for enrollment into their provider network, from the time the request is received by the payer until the provider has been credentialed and onboarded.
Two numbers are used to calculate this KPI: (1) the sum of time required to complete all healthcare provider enrollments (measured from the time that the enrollment request forms are initially submitted by the provider, until the insurance company has performed all required credentialing and account onboarding processes) over a given period of time, and (2) the total number of provider enrollment requests completed over the same time period. All forms of provider enrollments - paper, electronic, etc. - should be included in this calculation. Both new provider requests and existing provider re-credentialing should be included in this calculation. Do not include enrollment requests that were not approved by the insurance company in the numerator or denominator for this calculation.
(Sum of Provider Enrollment Request Cycle Times) / Total Number of Provider Enrollments Completed
The average number of days required to process, adjudicate and pay out a single approved medical insurance claim, measured from the time that the claims is submitted by the healthcare provid...
KPI Type : Service
Formula : (Sum of Medical Claims Settlement Cycle Times) / Number of Medical Claims Settled
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