8 Must Know Tips When Building Your Clinician Network
Multi-state licensure, credentialing, NCQA and payer contracts
As a telehealth company, having a clinician network licensed in all 50 states is crucial to growing your operations. However, processes like licensing and credentialing can be tedious and time consuming even when you plan for it accordingly.
The key to your virtual care company’s success is building a fully vetted, diverse and insured clinician network capable of offering its patients an exceptional care experience. These eight tips will set you on the path to building a clinician network successfully.
Identify priority states and clinician types
As with any new venture or expansion, it’s important to fully understand where your priorities lie. By making a list of the types of providers and states you want to focus on, it ensures you acquire the most important provider types and state licenses first.
Why is this important? Well, the hiring, licensing and credentialing process can take quite a bit of time. On average, it takes 60 - 90 days to receive a new clinician license and that doesn’t even include all the initial time it takes your team to fill out the applications. By having a plan in place first, it mitigates inefficiencies and allows you to expand your clinician network faster.
Offer multi-state licensure to your clinicians
The next tip towards building a successful clinician network is around multi-state licensing.
There are many complexities that come with medical licensing and credentialing. This area is extremely high stakes and could cost you tons in penalties, lawsuits and reputation damage if not fully vetted and maintained diligently.
It’s also quite costly and time consuming on the frontend to manage for your clinicians. However, it's a great investment if you're looking to expand into unique patient populations and meet demand. If you have the internal resources, outsourcing is another cost-saving option.
Medical licenses are required for each state a clinician supports patients in and regulations vary across states. It will cost about $1,000 per license per state and take three to six months to obtain each. Here are a couple ways you can streamline the process.
Submit multiple licenses at a time
Now, because each state has its own license requirements, obtaining multiple licenses can take some time. One tip to streamlining this process is submitting multiple licenses at once. This may seem simple, but to do this, you’ll need to be highly organized and detail oriented. If there are any mistakes found on any of the applications, they will be sent back and the process starts over.
Another way to streamline the licensing process is through the Interstate Medical Licensure Compact (IMLC).
What is the IMLC?
In the United States, states can participate in the Interstate Medical Licensure Compact (IMLC or the Compact). The IMLC’s mission is to increase access to healthcare, especially for patients in rural and underserved areas.
U.S. state medical boards developed the IMLC in 2013, with the thought that as telehealth grows - more and more clinicians will need multiple states licenses to effectively deliver care. The Compact was publicly announced in 2014 and was fully operational by April of 2017. Currently the IMLC includes 37 states, the District of Columbia and the Territory of Guam.
Clinicians must also meet certain eligibility requirements for the IMLC in order to join the compact.
Ensure every provider is properly credentialed
Hiring providers with confidence is crucial to the success of your clinician network and healthcare reputation.
Unlike the licensing process, which a governing body conducts, credentialing is organization specific. Credentialing occurs after the licensing process and is a way for the healthcare organization to ensure the clinician has obtained their appropriate licenses and education requirements. Essentially, credentialing is how the healthcare industry protects patients. It also plays a huge role in health plan enrollment and reimbursements.
If credentialing in house, be sure to prioritize and document standard credentialing criteria. Document every procedure, checklist and template and then build a standardized training for each credentialing specialist on how to properly follow them. If your resources are limited, outsourcing is a great time saving and cost-effective alternative.
Win payer contracts
Definitely easier said than done, but it’ll be a game changer if you can do it successfully. Unfortunately, it’s not uncommon for payer contracts to take upwards of a year or more. Here are a couple of things you’ll need to check off the list first before you try to go and win the hearts of payers.
Do your research first
If you’re reading this, you’re already off to a good start. It’s important to get an idea of which payers are going to make the most sense for you. Here are a couple of tips to help narrow it down:
Contact hospitals in the states or regions you’re looking at and see who they’re in-network with. Chances are, if they think it’s necessary, a large part of the population is covered by it.
Similar to hospitals, contact large employers in the states or regions you’re looking at to see who they’re in-network with.
2. Establish physical offices or Professional Corporations (PCs)
Professional corporations (PCs) are a specific type of legal business structure that is formed by licensed professionals to provide their services within certain regulated fields. The primary purpose of establishing a professional corporation is to provide a formal legal structure for professionals to conduct their business while still maintaining the benefits of limited liability.
3. Understand the types of services and their coverage
It’s important to know what services you offer and are planning to offer in order to understand how they might be billed. Most private and government insurers cover some kind of synchronous visit whereas asynchronous visits have historically been under insured.
4. Adopt HIPAA compliant technology
Before you even start the enrollment process, double check the patient visit software you plan to use meets HIPAA privacy requirements. That means having secure messaging solutions, hosting services and secure cloud storage services to keep their personal health information (PHI) safe.
Understand and prepare for enrollment bottlenecks
You won those contracts, now it’s time to enroll providers. The best way to streamline the enrollment process is to know what bottlenecks to look for. Here are a few to take note of.
Network adequacy/closed networks
It may be the case that the insurer you’re after already has an exclusive contract with another telehealth company. Unfortunately, there’s not much you can do about that. It is important, however, to do your research and be ready for it if it does happen.
Too many clinicians in-network
Sometimes insurers will deny providers simply because they have too many. It may save you a lot of paperwork and hair pulling to check with the payer before enrolling your clinicians.
When in doubt, include it
If you think you might need it, put it in the application. Not having enough information could lead to an enrollment denial and make you have to re-enroll. The fewer times you have to re-do it, the better. For everyone’s sanity.
Invest in thorough hiring, onboarding and training
Finding clinicians that align with your salary expectations, scheduling, location (in-person or virtual), patient needs and corporate values can be a tricky endeavor. It gets even more challenging when you narrow in on required specialties.
To find and hire 20 clinicians yourself, it’s typical to employ a team of four full-time recruiters tasked with placing and promoting the role, verifying employment information, interviewing candidates then actually securing them for the shift(s).
Then, you have to create an efficient onboarding process that identifies helpful resources, offers any needed platform training and clearly communicates your patient workflow. Without it, your new clinician network will be disorganized and ill equipped to handle patient visits.
If hiring that many internal recruiters sounds like a lot to bite off, outsourcing a full-vetted clinician network is another route. It can be a cost effective approach to building a clinician network if your internal resources aren’t quite there yet.
Obtaining an NCQA Certification
NCQA stands for the National Committee for Quality Assurance. It’s a non-profit organization in the U.S that focuses on improving the quality of healthcare by evaluating and accrediting various healthcare organizations and programs.
When an organization or program is NCQA certified, it means that it has undergone a rigorous evaluation process to demonstrate its commitment to providing high-quality care, improving patient outcomes and adhering to best practices in healthcare delivery.
Why is the certification meaningful? An NCQA certification is widely recognized as a symbol of quality in the healthcare industry and can help patients make informed decisions about their healthcare choices. Having your clinician network recognized for providing the highest quality of care builds trust and loyalty with your patients, setting you apart.
Outsource your clinician network all together
Did you know that 90% of healthcare executives are exploring cost-saving relationships with third-party vendors? It’s a great solution for virtual care companies looking to scale, but not wanting to invest or lacking the internal resources they need.
If your clinicians are serving patients all over the US, the resource requirements add up quickly. That’s why large telehealth companies typically hire multiple full-time specialists to stay on top of these 24x7. Combine those salaries with the cost per license per state, and it’s no cheap undertaking.
From there, each clinician needs to be credentialed with an in-network insurance payer at $200 per payer. Finally, there’s malpractice insurance that will run you about $24,000 a pop. The employer typically foots these bills for the clinicians.
Let OpenLoop help
It’s a lot of work, thankfully there are telehealth support companies out there doing the work for you! OpenLoop’s carefully curated provider network is NCQA accredited and covered by 600+ insurance payers including medicare, medicaid and every major insurance payer.
You’ll be able to hire providers with confidence knowing each one is carefully credentialed and vetted by our team of experts. With nationwide licensure, 30+ specialities and over 15 languages spoken, we help our clients easily fill their patient demand.
Interested in what we can do for your organization? Get in touch here!
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