As a healthcare provider, you're undoubtedly aware of the importance of maintaining your credentials and adhering to professional standards and regulations. Credentialing is the method of confirming and validating your qualifications, education, training, experience, and licenses required for your field of practice. This process is critical to ensuring the quality and safety of your services, as well as securing contracts and reimbursements from health insurance companies and other payers.

Credentialing can often be a complicated, lengthy, and expensive task that necessitates extensive paperwork, coordination, and follow-up. You will likely need to interact with several credentialing entities, such as hospitals, clinics, health plans, accreditation bodies, and state boards. Additionally, managing various deadlines, requirements, and changes in the credentialing process can be challenging. If you do not complete or update your credentialing on time, it can lead to delays, denials, penalties, or even a loss of privileges.

Therefore, a reliable and efficient healthcare credentialing software solution becomes invaluable, as it can help automate and streamline your credentialing workflow. This article aims to provide you with the necessary information and guidance to choose the best healthcare credentialing software for your practice.

But first, let's start with the basics.

What is credentialing and re-credentialing?

Credentialing is the process of verifying and validating the qualifications, skills, and competencies of physicians, nurses, therapists, etc. It involves collecting and reviewing various documents and data, such as licenses, certifications, education, training, and malpractice history, as well as screening providers against exclusion lists maintained by federal and state agencies, such as the Office of Inspector General (OIG) and the System for Award Management (SAM).

Re-credentialing in its turn is the process of re-verifying and re-validating the credentials at regular intervals (usually every two or three years) to ensure that they are still qualified and competent to provide healthcare services. Re-credentialing involves updating and renewing the documents and data collected during credentialing, as well as monitoring any changes or updates in the status of providers.

Credentialing and re-credentialing are essential for healthcare organizations as they ensure that providers:

• Meet the standards and requirements of accreditation bodies, such as The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA), as well as federal and state laws and regulations
• Are eligible to participate in Medicare and Medicaid, as well as contracts with payers, such as insurance companies and managed care organizations.
• Qualified and competent to provide quality and safe care to patients, as well as prevent fraud, abuse, or misconduct in healthcare.

However, they involve a lot of manual work — filling out forms, gathering documents, contacting sources, etc., which can be tedious, error-prone, and inconsistent. They also involve a lot of coordination and communication among various stakeholders, such as providers, credentialing staff, payers, accreditation bodies, etc., which can be difficult, slow, and unreliable. Not to mention loads of data management and storage, such as maintaining databases, records, files, etc., which can be complex, costly, and insecure

To overcome these challenges and streamline the credentialing and re-credentialing process, healthcare organizations may use credentialing software, which automates and simplifies the process of verifying, screening, and generating contracts, applications, and other forms for providers.

Read more about Top Credentialing Mistakes to Avoid for a Seamless Journey

Using credentialing software can provide many benefits for your practice. However, choosing the best one for your practice can be challenging. There are many factors to consider.

What Are the Key Features of Healthcare Credentialing Software?

When considering healthcare credentialing software, it's important to understand the key features that will optimize your credentialing process. Let's explore these essential functionalities that can streamline and enhance your operations:

Document management

Efficiently store, organize, and retrieve provider documents, such as licenses and certifications. Digitize and securely store them in the cloud to reduce paper clutter and storage costs.

Expiration management

Track and receive alerts for provider document expirations and renewals. Stay on top of deadlines and maintain valid and current credentials to ensure compliance with accreditation bodies and regulators.

Primary source verification

Validate provider information from trusted sources, such as state boards and national databases. Ensure accuracy, prevent fraud, and maintain the integrity of your providers' credentials.

Application management

Streamline and automate the creation and submission of provider applications to payers, facilities, or organizations. Improve accuracy and efficiency, reducing errors and delays.

Contract management

Create and manage provider contracts with payers, facilities, or organizations. Monitor contract performance and compliance by tracking terms, conditions, and rates.

Reporting

Generate and export reports on provider credentialing status, progress, and performance. Measure and improve your credentialing process while providing documentation for audits and inspections.

Workflow management

Automate and streamline credentialing tasks and workflows. Save time and resources by reducing manual work, improving consistency, and following standardized procedures.

Provider Portal

Provide an online portal for providers to access and update their credentialing information. Enhance communication and collaboration while empowering providers to manage their own credentials.

Integration

Connect your healthcare credentialing software with other systems or software, such as electronic health records (EHR) or practice management (PM) systems. Synchronize data across platforms and ensure consistency.

Security

Protect provider data from unauthorized access or breaches. Comply with data privacy laws and regulations by utilizing encryption and backup systems.

How to Compare and Evaluate Healthcare Credentialing Software?

Choosing the ideal healthcare credentialing software for your practice may be a daunting task given the many factors to contemplate and the numerous options available. To make an informed decision, you'll need to compare and evaluate different healthcare credentialing software based on your practice's objectives and requirements.

Here are the steps and criteria involved in comparing and evaluating healthcare credentialing software options:

1. Identify your practice’s goals and needs for credentialing software

Begin by defining your practice’s goals and needs for credentialing software. Ask yourself:

• What are the main challenges you face in your current credentialing process?
• What objectives do you aim to achieve with credentialing software?
• What essential features do you need in credentialing software?
• What would be nice-to-have features in the software?
• How many providers are there in your practice?
• How varied are your providers’ credentials and specialties?
• How often do you need to credential or re-credential your providers?
• How much time and resources are you planning to spend on credentialing tasks?
• What budget do you have for credentialing software?

By answering these questions, you can narrow down your options and focus on the most relevant ones.

1. Research and shortlist potential credentialing software vendors

Find out information about potential vendors, such as their market reputation, product features, pricing options, customer reviews, and levels of customer support. Use online directories like Capterra, G2, or Software Advice to browse and compare different credentialing software options. Also, consider referrals from other healthcare professionals who are using different credentialing software options

2. Request and review product demos or trials

Get a practical feel for how different credentialing software options work by requesting product demos or trials. Check for features, usability, performance, and customer support while reviewing the demos or trials.

3. Compare pricing and value propositions

Understand how much different credentialing software options cost and the value they offer for your practice. Compare upfront costs, ongoing costs, return on investment (ROI), and customer satisfaction with different credentialing software options.

4. Make a final decision based on your practice’s priorities and preferences

Finally, weigh the pros and cons of each option and choose the one that fits your practice’s budget, workflow, and goals. Use a scoring matrix, pros/cons list, or ranking method to make a final decision based on your practice's priorities and preferences.

By following these steps, you can choose the best healthcare credentialing software for your practice.

How to Implement and Maintain Healthcare Credentialing Software?

Once you've chosen the right healthcare credentialing software, the next crucial step is to put it into operation and sustain its performance in your practice. This process, which encompasses planning, execution, training, and continual upgrades, can be demanding, but adhering to certain steps and good practices can ease the process.

Here's a step-by-step guide on setting into operation and sustaining your healthcare credentialing software:

Creating a Strategic Plan for the Deployment

The commencement of the healthcare credentialing software implementation lies in formulating a strategic plan. This involves:

Formulating a Timeline: Determine a feasible timeline for the software's deployment. Take into consideration your practice's scale, the diversity of your providers, and the chosen software's functionalities.

Defining Duties: Distribute roles amongst your team members, clearly explaining their responsibilities throughout the implementation.

Engaging Stakeholders: Engage all stakeholders involved in the process, keeping them abreast of the deployment timeline, and potential challenges, and addressing any concerns or questions they may have.

Transition and Validation of Existing Provider Data

The second step involves transitioning your existing provider data into the new system. Key aspects include:

Data Backup: Ensure to make a secure backup of your provider data prior to its migration to the new system.

Data Clean-up: Confirm your data's integrity and ensure it aligns with the new system's requirements.

Data Verification: After transitioning your data into the new system, confirm that all data is correctly and completely transferred.

Training Staff on the New System

The third step revolves around training your staff to operate the new system effectively. Important elements to consider include:

Providing Detailed Manuals: Supply your staff with comprehensive guides that explain how to navigate the new system.

Creating Informative Videos: Develop video tutorials that give a step-by-step walkthrough of the system, illustrating its functionalities with examples and tips.

Offering Live Sessions: Arrange webinars or live sessions to address any queries and provide real-time guidance to your staff.

Observing and Assessing System Performance

The fourth step is monitoring and evaluating the new system's performance. Here's what you need to do:

Track Performance Indicators: Monitor key metrics to understand the system's performance, including time and cost savings, compliance improvements, and customer satisfaction. These metrics should be compared against your practice's previous performance.

Collect Feedback: Gather opinions and suggestions from stakeholders to understand their experiences and any potential improvements they may see fit.

Resolve Issues: Identify and troubleshoot any issues arising from the new system's use or implementation to prevent them from recurring.

Regular System Updates and Optimization

The final step is to regularly update and optimize the new system, which involves:

Installing Updates: Regularly install new features or patches for the system, ensuring they are compatible with your practice's existing devices and systems.

Modifying Settings: Adjust the system's settings or workflows as per your practice's evolving needs for optimal efficiency.

Seeking Support: If there are any difficulties or challenges with the new system, don't hesitate to contact the vendor's customer service for assistance.

By following these steps, you will ensure that the healthcare credentialing software is implemented successfully and maintained optimally, aligning with the needs and goals of your practice.

FAQs About Choosing the Best Healthcare Credentialing Software