Data Migration Issues in Credentialing

Data Migration Issues in Credentialing

Expert Insights

CASSIE KANA CARTER

CPMSM, CPCS

Cassie is an expert in the field of Master Data Management (MDM) and Provider Credentialing in Healthcare. She is the recipient of the 2018 HCPro Credentialing Resource Center Case Study Award for excellence in Medical Staff Professionals.

A dual-certified professional, Cassie brings over 16 years of experience working in multi-state Medical Staff Credentialing, Payor Enrollment, and Master Data Management.

LENNY GEORGE

CEO, Cquensys

At Cquensys, we empower health systems to automate workflows, implement enterprise-wide credentialing applications, and harmonize data into a single source of truth. As the world of healthcare continues to evolve, we help medical staff offices navigate the challenges of keeping up with rapidly changing requirements and evolving demands.

We cover the entire spectrum of credentialing-specific services, including:

Strategy Development & Product Evaluation
Project Management
Workflow Automation & Implementation
Data Migration & Expert-level Data Cleansing
Medical Staff Service and Payor Enrollment Staffing

Our experts also guide the implementation of enterprise-wide data management programs across various domains, such as healthcare and finance.

In this edition of ‘Expert Insights,’ it gives me great pleasure to introduce and interview an industry expert in the field of Healthcare Master Data Management (MDM) and Provider Credentialing – Cassie Kana Carter, CPMSM, CPCS.

3. Insurance or medical malpractice tables

Insurance and medical malpractice tables offer the same issues as hospital affiliation and university tables, plus a few more.

For example, the company ACORD is often misclassified as being an insurance company. In reality, they develop standardized documents. However, since their name is the header for half of the malpractice face sheets that health systems receive, they are mistakenly added as “ACORD Actual Insurance Name,” or with other such errors.

An expert with hands-on experience in facilitating large-scale data migration efforts could quickly identify and help avoid such issues.

4. Expertise or Specialty

This category refers to a provider’s practicing specialty at their current facility and must not be confused with the board certification specialty category.

This data is frequently shared with multiple locations, so data cleansing before migration is essential. Otherwise, for a cardiologist, for example, you may end up with variations like ‘Cardiology,’ ‘Cardio,’ ‘Cardiovascular,’ and ‘Cardiovascular Diseases’ representing the same specialty.

In some credentialing applications, these values are also shared with the payor enrollment module tables, which means that payor rosters may be adversely impacted.

Unfortunately, the negative effects of this issue may not be apparent until a few months after the data merge, for instance, when your CMO requests a quick update on the total number of cardiologists on staff and encounters challenges due to the naming variances.

Ensure acute care facilities are assigning provider expertise by facility if they aren’t already doing so. This is important because a provider might practice as an interventional cardiologist at a trauma hospital and as a general cardiologist at a critical access hospital. Similarly, a nurse practitioner might work in radiology at one location and pediatrics at another.

More and more functions are dependent on a provider’s practicing specialty. This is why practicing specialties must not be tracked solely by board certifications.

Web directories, referral management services, payors, healthcare integrated networks, and regulatory agencies all require that a provider’s specialty be defined by their practicing role.

5. Document Type Codes and Descriptions

Have you ever seen images or documents, such as a Malpractice Face Sheet, categorized under various names like ‘Malpractice,’ ‘Malpractice Insurance,’ ‘COI,’ ‘Mal,’ or other descriptions? Multiple descriptions for the same document can create confusion.

Many credentialing applications lack the capability to merge document names. When ‘Document Type Codes’ and ‘Descriptions’ are not standardized before records are migrated or merged from legacy sources, this issue arises.

The names of documents are often tied to processes built into the system. For instance, your initial credentialing process may require scanning in ‘Med Mal,’ while your recredentialing process might refer to the same document as ‘Malpractice.’

Without standardization, it becomes very challenging to remember where a document should be filed, especially for new employees. It also makes it extremely difficult to locate items during an audit.

Industry Insights