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Use caseUC0034

Check a clinician's credentialing file before committee review

Every provider file has to be read for any sanction, however mildly worded, and its license and verification dates checked against the start date. This app reads each file, fills in ten details and flags the ones the committee must review.

For the credentialing teamCross-domain · Healthcare

Why it matters

Today's manual process, and the same job with the app

A credentialing team at a health plan or medical group, preparing provider files for the credentialing committee.

✕Today's manual process

1Read every file to pull out the name, NPI, license and verification details.
2Check each date manually against the file's effective date: is the license expired, is the check stale?
3Judge the finding and decide whether a mildly worded reprimand still counts as an adverse action.
4One miss lets an adverse action reach the committee unnoticed.
Every file read and checked manually

✓With the app

1Each file is read, and ten details are filled in, each pointing to the section it came from.
2The dates are checked against the effective date, and an expired license or stale check is flagged.
3Any adverse action is flagged, however mildly worded, with the reason shown.
4The committee still decides. The app flags and explains; it never approves a provider.
Flagged files arrive with the reason

See it work

One real case, read by the app, step by step

Jordan K. Haddad's file shows a public reprimand, followed by “license otherwise active and in good standing.”

Check a clinician's credentialing file before committee reviewReference appBuilt to be shaped to your process
  1. 1The provider's file name, NPI and license number read out, each tied to its section.
  2. 2The dates license expiry and the latest check, both measured against the effective date.
  3. 3The finding a public reprimand, though the same line says “good standing”.
  4. 4What does not clear it “good standing” does not cancel the reprimand: adverse action found, yes.
  5. 5Sent to committee flagged for review, with the reason. The committee still decides.

For engineers

How it is built, and how we measured it

All fourteen steps of the build are written up, from the business case to running it in your own environment.

Kit overview →
35 of 35files needing review were flaggedmeasured in 06 Evals →
0 of 20clean files flagged by mistake
550 of 550file details read exactly rightmeasured in 06 Evals →
7.1¢to check all 55 filesmeasured in 07 Unit cost →

The build, step by step

14 steps

Make it yours

What you see is a reference app. We shape it to how you work.

Every part of it is built to change, and none of it means starting over.

Your rulesYour recredentialing window, how old a verification check may be, and what counts as adverse.
Your recordsThe provider files, applications and verification reports your team already keeps.
Your systemsYour credentialing system and the queue your committee coordinator works from.
Your screensThe fields, wording and layout your credentialing team already uses.

Want this for your team?

Talk to us

We can run this on your own provider files, with your own credentialing rules, inside your environment.

Talk to us →
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