Why Use Automated Medical Credentialing? Advantages Of A Medical Credentialing Solution

Medical credentialing is one of the most important considerations for medical practitioners and healthcare service providers. Medical practitioners would not be enlisted as trusted providers in insurers’ networks without medical credentialing. Insurers’ customers will not seek treatment from medical practitioners not listed in their insurers’ networks. Therefore, not undergoing a medical credentialing process with insurers puts healthcare providers at risk from opportunity losses.

What is the typical credentialing process a medical credentialing solution will automate?

 

Automated medical credentialing provides a paperless way for a healthcare provider to get medically credentialed with an insurer.

 

Identification of documents

An automated credentialing solution identifies the medical credentialing documents such as medical practitioner educational qualifications, licenses, certifications, affiliations, etc. The solution has integrations with many private and government document verification solutions. The documents are automatically verified and validated; any mistakes are communicated back.

 

Create insurer-specific workflows

Automated medical credentialing solutions can detect insurer credentialing workflow changes and accordingly update its system. New sets of requirements from the insurer are known to providers via the solution. Such a facility helps providers to apply with multiple insurers. Not only do providers increase their reach and span of service, but people can get treated by medical practitioners from diverse backgrounds and skillsets.

 

CAQH completion

Some insurers require providers to use CAQH (Council for Affordable Quality Healthcare) to apply for medical credentialing. Upon successful application processing with the insurer, the insurer provides a CAQH number as the first step towards provider credentialing. An invitation link is sent to the provider to complete the CAQH form online. The CAQH form is large, containing scores of pages, and a medical credentialing solution can auto-populate the form based on configuration.

 

If the form were manually filled, it could produce errors. And rectification of errors will result in further delay of the process. After the initial application is submitted, the insurer would require the provider to re-attest four times a year. This is done to maintain the eligibility of the provider with the insurer. The re-attestation process can be automated too.

 

Verification and re-credentialing

The healthcare provider credentialing verification process is lengthy and could take several months. Mistakes in the application that could have been avoided by using medical credentialing software could cause the credentialing process to delay further. After getting credentialed, a provider may require to get re-credentialed periodically with the insurer.

 

Conclusion

The length and cumbersome workflows of traditional credentialing processes will soon phase-out, and automated solutions will take over, reducing the burden on credential and compliance staff. With automation, providers, payers, and patients will benefit immensely. New-age healthcare delivery mechanisms such as value-based healthcare delivery will receive a boost.