Traditionally, credentialing has been a time-consuming, manual, and error-prone endeavor, often causing delays in provider onboarding and scheduling, along with the revenue that comes from patient care. However, automation is stepping in, swiftly changing the medical credentialing arena for the better. In this article, we delve into what provider credentialing entails and how automation is streamlining the process. This shift is not only enhancing efficiency and provider satisfaction but also speeding up the time to revenue for healthcare organizations.

Provider credentialing, although essential, is a resource-intensive venture that can add substantial cost and time to the payer's bottom line. In a bid to attain higher efficiency and manage provider data effectively, many plans and hospitals are pivoting towards digital platforms and processes. The healthcare sector, albeit slowly, was inching towards technological adoption. However, the tumult of 2020 catalyzed this transition. According to a survey by PwC’s Health Research Institute, the surge in virtual care and the attempts to mitigate revenue losses propelled health systems towards digital pathways, fundamentally altering healthcare delivery.

The survey revealed a significant uptick in the automation of administrative tasks, with 73% of provider executives acknowledging the shift. Additionally, nearly half of the payer executives surveyed pointed towards investments in digital support and educational tools aimed at enhancing the member experience. These statistics underscore a broader acceptance and investment in digital tools, especially in supporting provider credentialing and payer enrollment processes.

Understanding Provider Credentialing

Credentialing is a meticulous process aimed at verifying the qualifications, education, training, and professional background of healthcare providers during onboarding. It's a pivotal step to ensure that medical practitioners are well-qualified to adhere to industry standards and meet regulatory mandates. Following credentialing, privileging further confirms the competencies of providers in delivering safe and quality patient care. These processes are indispensable and are typically orchestrated by healthcare practices, hospitals, health systems, insurance payers, and other relevant entities.

Historically, the credentialing and privileging processes have been inundated with manual tasks. These range from collecting and reviewing paper-based documents, liaising with educational institutions, and licensing boards, conducting background checks, and orchestrating document signatures. This manual drudgery not only amplifies the administrative burden on providers and credentialing specialists but also triggers frustrating and potentially costly delays in scheduling providers and initiating patient care.

The conventional pathway of credentialing involves providers filling out and submitting their applications manually. Post submission, the health plan's credentialing team meticulously sifts through the application, validating providers’ educational background, training, employment history, and state licenses among other details. This verification may extend to background checks, identifying previous disciplinary actions, and checking for current sanctions or exclusions. The process is intensive, involving numerous phone calls, form fillings, email correspondences, and relentless tracking of these requests, especially when responses are tardy.

Credentialing is not a one-off task. It's a recurring process, and when you consider the volume - thousands of providers across numerous healthcare provider networks - it's easy to fathom why healthcare administration is enmeshed in bureaucratic red tape.

The extensive process of credentialing comes with its own set of challenges and pitfalls. Read more about Healthcare Credentialing in 2023: Navigating the Landscape and equip yourself with the knowledge to navigate it proficiently.

Issues with manual credentialing

The manual rigmarole of credentialing presents a host of issues affecting not just health plans, but also providers and ultimately, patients. On average, medical practices expend $7,000 on each provider credential application, coupled with 20 hours of administrative time. The manual nature of these processes renders them susceptible to human errors. A simple misentry of a phone number, email, or address can set off a chain of time-wasting activities, leading to delays in approvals for providers. These delays can span months, impacting the practice’s revenue and patients’ access to care.

But what transpires when a document is amiss, or a practice relocates, or a license expires leading to delays in employment verifications? Unfortunately, more delays.

Credentialing is indispensable. It's a cornerstone in ensuring that patients receive quality care from qualified providers. However, the traditional process is screaming for an overhaul. Automation emerges as a viable solution to pare down human errors and obliterate delays ingrained in manual processes. It augments efficiency across the entire credentialing journey, from application to the completion of primary source verifications.

Credentialing isn't devoid of mistakes, but identifying them early can ensure a seamless journey. Discover common credentialing mistakes and learn how to avoid them for a smooth credentialing journey.

Streamlining the Credentialing Process

Automation is acting as a catalyst in transforming the provider credentialing process. Cutting-edge credentialing software is at the forefront, facilitating faster completion of credentialing, privileging, and payer enrollment processes. This not only expedites patient access but also mitigates potential revenue disruptions.

  • Configurable Workflows: Modern credentialing systems empower you with the ability to tailor workflows to your organization's unique needs, thereby creating a repeatable, predictable, and scalable process.

  • Data Collection and Verification: With the help of modern credentialing software, duplicate work, and needless back-and-forth communication are significantly reduced. Providers can effortlessly upload files, auto-populate forms, and e-sign documents—all in adherence to eSignature laws, SSL encryption, and HIPAA compliance. Moreover, automated primary source verifications for state licenses, DEA, SAM, OIG, and more, save time and bolster data accuracy. These automated facets not only lighten the load on overburdened credentialing specialists but also enhance the provider experience right from the onset.

  • Monitoring and Reporting: Tracking dashboards, configurable alerts, and detailed reporting offer a real-time glimpse into provider credentialing, privileging, and payer enrollment status. Automated reminders about expiring documents, re-appointment, and payer re-credentialing ensure your organization remains compliant and maximizes opportunities for complete reimbursements.

Choosing the right credentialing software is a decision that can significantly impact your healthcare organization. Learn how to make an informed choice and what factors to consider in our guide on choosing the best healthcare credentialing software.

The Advantages Add Up Quickly

The adoption of automated provider credentialing, privileging, and payer enrollment solutions is laden with benefits. Improved efficiency and data accuracy translates to faster processing, minimizing the interval from provider hiring to patient care delivery. Providers relish the reduction in paperwork and the ability to commence patient care sooner. Moreover, your existing credentialing staff can onboard more providers in less time, enhancing productivity and cost-efficiency.

Automated credentialing software significantly diminishes the risk of non-compliance errors often witnessed in manual methods. The verification process is automated, and data cross-referencing can dramatically reduce the likelihood of fraudulent or expired credentials slipping through the cracks — a benefit that not only ensures patient safety but also shields your healthcare organization from legal liabilities.

Lastly, automated provider credentialing software furnishes healthcare leaders with the pivotal information required to plan to staff adequately and ensure providers are primed to deliver and get reimbursed for patient care.

Credentialing software is your ally in avoiding exclusions and sanctions, ensuring you stay compliant and mitigate risks. Learn how to leverage credentialing software to its full potential and safeguard your practice.

Is It Time to Streamline Your Credentialing Process?

Credsy addresses the outlined manual inefficiencies, enhancing data accuracy, bolstering compliance, and expediting revenue realization. Transitioning to our platform paves the way for a more streamlined, accurate, and provider-centric credentialing paradigm, embodying the modern exigencies of healthcare administration.

Reach out to us and navigate towards an automated credentialing framework, positioning your organization at the vanguard of healthcare administrative advancement.

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