What is medical credentialing?
Credentialing in healthcare is the process by which medical organizations verify the credentials of healthcare providers. This ensures they have the licenses, certifications, and skills to care for patients properly.
Therefore, this process determines whether an individual is qualified to perform the duties they are being considered for at a facility and/or under an insurance carrier’s health plan.
After verifying credentials, practitioners are credentialed and privileged. This means the insurance carrier initially verifies the qualifications, education, and license, usually every three years.
How are medical staff credentialing and privileging being handled?
The credentialing and privileging process is complex, time-consuming, and detail-intensive. Above all, this tedious task takes a lot of work, as well as follow-up and tracking.
Therefore, let’s review how the process goes:
- Organizations must collect the required information from applicants. The applicant is responsible for being truthful throughout the application process. However, it is the duty of the healthcare organization to verify accuracy.
- Conducting primary source verification (PSV) of all the provided information: PSV is obtaining licensing and credential information. This process can be done directly from the source that issued the credentials. It can also be done from a secondary source with the right to verify that information.
What are the main reasons to outsource your medical credentialing?
Outsourced credentialing offers a high-tech solution that minimizes the errors and omissions often caused by antiquated manual credentialing processes.
1. Fewer human errors
According to research, healthcare centers using software solutions saw a reduction in complaints, complications, and costs. Health Prime Credentialing allows a considerable reduction in errors, which used to be expected in manual processes.
2. Cost-effective
Nearly every healthcare center, big or small, must face budget constraints and difficulty reducing operational costs and streamlining processes. Therefore, outsourcing credentialing can reduce paperwork and errors without impacting patients’ health or safety. Prime Credentialing has been shown to save between 20% to 80% over in-house credentialing.
3. Quicker turnaround
Outsourcing credentialing services saves healthcare providers time and effort and ensures timely reimbursement. The standard time it takes for healthcare insurance carriers to verify credentials is 60-120 days. This allows us to keep the process moving so the estimated timeline is completed and physicians can work without worries.
4. Less paperwork/Greater security
Health Prime Credentialing uses Modio Health to gather and store online, secure provider profiles. This allows remote access with easy editing, uploading, and sharing of documents and profile data instead of filing cabinets.
5. Improved efficiency
In many healthcare organizations, spreadsheets, paper documents, and checklists are spread over different departments. Updating many documents frequently increases the paperwork. On the other hand, our system helps to verify, update, and check for errors quickly. Having a central database helps prevent lengthy times in setting up perimeters, storing follow-up and payer status data, and giving easy access to analytics.
Automation frees administrative staff from manual tasks, allowing them to focus on other duties within your medical practice. Outsourcing your credentialing services can reduce human errors significantly and save costs.
A delay in credentialing can lead to a period where the physician is not working or not seeing patients with specific insurances. This leads to lost income from delays that can be more than the cost of the credentialing outsourced service.
At Health Prime, we can help!
Health Prime offers Prime Credentialing, our solution that offers multiple types of services depending on your medical practice needs:
- Add / Remove a new provider from the practice.
- Change of Demographic data (bank change, update service or remit to address, etc).
- Maintain contracts / Expirable documents.
- Credentialing Research to determine provider status.
- CAQH Enrollment / Re-attestation (maintenance).
- Payer re-validation.
Outsourcing the credentialing process helps medical practices focus on patient care and allows Health Prime to gather, filter, report, and manage the verification process unbiasedly. We also stay updated on the changing government regulations, so the practice does not have to worry about credentialing compliance issues.
If you want to know more about how outsourcing your credentialing processes can improve your medical practice, contact us at [email protected]. Set up a meeting to discuss how we can help you get back to what matters most: your patients.
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