Health Net Credentialing Process Improvement Case Study

This case study documents Health Net's efforts to enhance their credentialing and primary source verification process following their acquisition by Centene. The need arose to credential a 27% larger network of providers under accelerated timelines. Health Net faced challenges such as high data acquisition costs, human errors, and manual processes. To address these issues, Health Net explored working with a Credentialing Verification Organization (CVO) and ultimately chose CAQH due to their positive prior experience. The implementation of CAQH's Primary Source Verification (PSV) services led to a one-third increase in file volume and a 5% improvement in overall data quality. Additionally, Health Net achieved a 12-day reduction in the time required to complete PSV files and reduced labor costs by 20%. The automated processes replaced the previous manual verification methods, ensuring compliance with NCQA standards and enhancing operational efficiencies, thereby allowing Health Net to scale for future growth.