Ophthalmology & optometry case study
Bringing credentialing into focus
A large eye-care group came to pie looking for more than help with applications. It needed experienced credentialing professionals and dependable software that could bring its provider information, payor relationships and ongoing work into view. Nearly five years later, that partnership continues across a multi-state organization with more than 70 clinicians and 20-plus offices.
A complex business needed a connected solution
This regional medical and surgical eye-care organization brings together ophthalmologists, optometrists and surgical specialists across multiple affiliated practices in the Northeast. Its clinicians may work in more than one state, move between offices and appear on different practice rosters. Each combination brings its own payor requirements, participation details and deadlines.
The organization wanted professional services backed by software it could rely on: a team to manage the work and a clear view of the information behind it. An enrollment status alone was not enough. The business needed to understand which provider could serve which office, under which practice entity, with which payor participation in place.
Turning inherited records into a working system
When the previous credentialing arrangement was ending, pie inherited information maintained in spreadsheets. Some records no longer reflected the organization as it operated. Payors were mixed together with lines of business, office assignments had changed, and provider departures were not always reflected in the information left behind.
A populated cell could look reassuring without answering the practical question behind it. Did the entry describe the payor, a particular product or a network? Was the provider still working at that office? Was there evidence of participation, and did an effective or revalidation date apply to that relationship?
Moving forward required more than transferring those cells into a new screen. It meant researching the relationships, testing inherited information against available evidence and connecting the records to work that could be assigned, followed up and understood. New enrollments and time-sensitive revalidations still needed attention while that picture was being established.
Understand the payor mix
The intelligence behind every enrollment
pie’s payor intelligence engine connects payors with their lines of business, networks and enrollment requirements. Documented pathways, supporting sources and payor-specific instructions give our team a foundation for the work. Human research and agent-assisted review keep that knowledge current as requirements change.
The payor portfolio is a useful place to understand the operation pie manages today. It brings the organization’s payor connections into one view and provides a route into each agreement, its recorded programs and networks, and the providers and work connected to it.
That structure matters because a payor name is not the same thing as a line of business or a product. Commercial participation does not establish Medicare participation, and a group agreement does not by itself confirm every provider at every office. Those distinctions need to remain visible.
From that overview, the team can examine the participation on record, identify relationships that need further investigation and connect effective dates and revalidation requirements to the relevant provider, practice and location. Unknown information remains a question to resolve rather than a blank treated as confirmation.
Connect the provider record
A complete picture of each provider
pie brings provider profiles, licenses, supporting documents, attestations and contracts into one connected platform. Document review, primary-source verification and expiration tracking remain distinct, making it clear what is on file, what has been verified and what needs attention.
Provider and payor profiles give that portfolio its working detail. Licenses, practice affiliations, supporting documents, enrollment information, contracts and project history can be managed together instead of scattered across spreadsheets and separate files.
The distinctions within those records matter, too. Receiving a license document is different from reviewing it or verifying its status against a primary source. Keeping the evidence and dates with the record helps the next person understand what is known and what still needs attention.
For the client, the value is both professional oversight and visibility: an experienced pie team managing the details, with a shared place to see the information supporting the work.
Move enrollments forward
A clear path for new and inherited work
Enrollment work rarely starts with a clean slate. pie’s enrollment discovery process helps establish what is already in place, what remains uncertain and what needs action. Our payor intelligence engine and documented recipes support new applications, inherited projects and revalidations, with requirements, milestones and follow-up connected in one system. Automated workflows keep work moving; our team investigates gaps, handles exceptions and confirms outcomes.
An application is part of a continuing process. Requirements must be understood, information assembled, submissions made and responses followed through to an outcome. New providers, locum assignments and returning clinicians can each create work across several practices, offices and payor relationships.
pie’s established payor intelligence engine and documented payor recipes support that work. Our project management system connects the requirements with ownership, recorded activity, milestones and follow-up, while the team handles exceptions and the details that need judgment.
When participation is confirmed, the record needs to say more than “done.” A useful client update identifies the provider, payor, applicable office and effective date, explains what was confirmed and preserves the supporting history. That is information the organization can use after the project is closed.
Make progress visible
Clear reporting starts with connected work
pie’s reporting draws together provider information, enrollment records and project activity. Participation, effective dates, outstanding requirements and next actions can be reviewed in context, giving clients a practical view of what is complete, what is moving and where their input is needed.
Accurate reporting depends on the information and activity beneath it. A completed project, an application under review and confirmed participation represent different things; a useful report keeps them distinct.
Progress summaries, provider briefings and enrollment matrices organize completed work, outstanding requirements and next actions around the people and payor relationships the client manages. They give the organization a practical way to see where participation is recorded and where further attention is needed.
The point is not another status spreadsheet. It is a clearer account of what pie has done, what is still moving and what the client needs to help resolve.
What the organization has today
Nearly five years into the partnership, the organization has a shared system for its credentialing information and an experienced team responsible for the ongoing work. That combination provides a practical foundation as providers, locations and requirements change.
- Brought inherited spreadsheet-based information into a shared, maintained system.
- Organized payor, product, provider and office relationships into a clearer participation picture.
- Connected provider information, licenses, supporting documents, contracts and expirables in one place.
- Documented enrollment outcomes with effective dates and supporting evidence.
- Made ongoing work visible through project updates, scheduled follow-up and client reporting.
- Supported approximately 100 providers over the partnership, including new starts, locum assignments, departures and returns.
Managing credentialing for 70+ providers across five states and dozens of payors used to feel overwhelming. Since working with pie, I have more clarity and fewer headaches. The software keeps everything organized, their team is responsive and knowledgeable, and the regular check-ins help us stay on track. I feel confident things are getting done, and we know we’re a priority. From PSV to tracking contracts and expirables, pie handles the moving parts so we can focus on patient care.