Provider360™ Credentials Verification Features

Supplemental Credentialing Services

OptumInsight offers numerous products and services that will complement our credentials verification services.

In addition to primary source verification, OptumInsight offers ongoing credentialing support in a consulting capacity to assist with policies and procedures, process workflows, team structure, and compliance questions, as needed. Additionally, OptumInsight can provide several complementary services that include ongoing monitoring of sanctions, facility credentialing, and site visits.

Certification

Our verification services are fully certified by NCQA* and accredited by URAC.  Additionally we are compliant with JCAHO verification standards, as well as CMS standard primary source verification requirements.

Stability

Our credentialing unit is one of the most mature in the industry.  In 1997, we began as Aperture Credentialing, Inc., a spin-off from a major health care organization.  Today we are an Optum subsidiary with credentialing operations that are financially sound and backed by a multi-billion dollar company.  Although our name has changed, our focus to improve the health care system has remained a constant.
In addition to our financial and organizational stability, we present a long-term system and strategic stability. The technology systems for our credentials verification work are designed and operated by Optum, giving us a unique advantage into system compatibility, redundancy, and future strategic direction.

Innovation

Because the credentialing process is largely dictated by accreditation bodies, the key to innovation in credentialing is technology. To that end, OptumInsight has developed numerous first-to-market technologies that are a part of your standard credentials verification package:

• Email and fax-based auto-messaging system to providers that increases speed and reduces paper
• Client portal that enables users to generate network reports or drill down to provider-level detail
• On-demand PDF generation of completed applications and documents
• Data stored temporally—allows viewing verification data at any historical date
• Dynamically-built online provider data collection portal
• Fax-based imaging system that reduces resources and improves accuracy

Experience

With an operations management team that has over 10 years of experience focusing on credentialing, we offer the most experienced credentialing management in the industry.  The OptumInsight verification team includes highly skilled individuals in all aspects of credentials verification.  This dedicated unit, many of who have earned their Certified Professional Credentialing Specialists (CPCS) designation, processes over 550,000 credentialing events per year.

Operations

Our operational model and proprietary workflow and imaging system is capable of handling the regular volume fluctuations in the credentialing cycle. We have the resources to handle significant volume increases (or decreases) efficiently. In fact, many of OptumInsight’s operational resources are cross-trained to support multiple health plans, providing for increased efficiency and backup during periods of fluctuating volume. This significantly reduces overhead, as well as assuring operational fluidity and general knowledge about such systems, which is critical for supporting your credentialing needs.

Additionally, our solution assures:

• Consistent security and privacy policies and practices
• Common data standards and exchange protocols
• Streamlined administration (billing, IT, QA, reporting, etc.)
• Simplified implementation with common resources
• Coordinated support and training

*The National Committee for Quality Assurance (NCQA) is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral organizations, practitioner organizations and credentials verification organizations.