10 Must-Have Features in Your Healthcare Credentialing Software

‘Tell me about your experience and educational background,’ – does this sound familiar? Chances are you must have faced this classic job interview question at least once in your lifetime. A person or business with good credentials finds favor in every profession and industry. This article deals with healthcare credentialing, the advantages of automated provider credentialing, and 10 features you should look for in healthcare credentialing solutions.

Introduction to Credentialing Software

‘Credentialing’ can be loosely defined as a process used to assess the educational background, training, and practice history of a medical provider. Provider credentialing has existed for centuries, but it was only around 1990 that national organizations gave credentialing a formal structure. These organizations defined the criteria for credentialing physicians, physician assistants, and nurse practitioners. One of these criteria is the confirmation of the board certification, qualifications, malpractice claims, etc. from the primary source of the credential.

Credentialing software helps healthcare providers save time, and money, and minimize errors by automating tasks that were previously carried out using stacks of paper forms, spreadsheets, and emails. This improves efficiency, enhances regulatory adherence, and leads to smooth operations across the organization.

Key Benefits of Healthcare Credential Software for Your Organization

Before diving into the features, implementation, and challenges of the healthcare credential software, it is important to recognize the impact that the software can have on streamlining processes by ensuring the accuracy and compliance of provider credentials. Here are a few benefits that the software offers:

1. Accuracy and Efficiency:  Provider credentialing software eliminates the need for manual data entry and paperwork thus reducing the risk of errors and improving accuracy.

2. Time-saving: Automating the credentialing process can reduce the time required to gather and verify the provider’s information. This helps the organizations expedite onboarding and maintain compliance with minimal administrative burden.

3. Real-time Updates: With this software, organizations can conveniently access real-time updates on provider credentials. This facilitates the tracking of expiring license certificates and other credentials.

4. Comprehensive Provider Profiles: Provider credentialing software comes with a feature that helps create comprehensive profiles to capture all relevant information, making it easy to assess qualifications and track ongoing compliance.

Manual Credentialing Vs. Automated Credentialing

Manual credentialing requires the support of a dedicated full-time credentialing team. It also requires a lot of paperwork, such as going after people for signatures, reaching out to different organizations for information, and sharing that data with other institutions through fax, and so on. Outdated manual credentialing software relies on Excel sheets, filing cabinets, post-it notes, and spreadsheets, which create obstructions in healthcare organizations’ ability to cater to changing patients’ needs and have a major impact on revenue.

Automated credentialing can offer substantial advantages over a manual credentialing process. By automating the credential process, healthcare organizations can focus more on patient care than administrative duties. Due to this efficiency, the credentialing process can be completed more quickly and with fewer resources. This saves healthcare organizations a lot of money and time and optimizes return on investment. Adoption of automated provider credentialing has benefits that add up quickly:

If you are still unsure whether you should opt for an automated credentialing solution or stick to manual credentialing, this table compares the two and explains why an automated solution would be a better fit for your organization.

Mistakes in the Credentialing Process

The credentialing process in healthcare is not a breeze. One mistake and the physician’s whole career could be in jeopardy and the consequences could be catastrophic. From financial losses to legal complications, credentialing mistakes can make physicians and healthcare facilities suffer. What can those mistakes be? Below are a couple of mistakes that can happen in the credentialing process. Take a look-

1. Mistakes in Planning

It’s a known fact that the credentialing process takes time. Loads of document collection and verification take a couple of months to complete. Sometimes it can take more time. The biggest mistake the healthcare facility or staff can make is to fail to plan for this delay in the process. Both the HCP and the facility suffer from this. 

The healthcare professionals’ time is at stake, as they can only render care services if they are credentialed. Moreover, the healthcare facility can only get reimbursed if the caregiver is credentialed. It’s a financial loss for the healthcare company. So, proper planning, keeping in mind the potential time frame, is important to avoid losses.

2. Errors in Data Entry

Making human errors in filling out the credentialing application is quite a common mistake. Different types of errors can cause the delay or denial of the application. Well, typo errors are quite common mistakes that happen while entering data. Missing words or interchanged information leads to obscurity. It’s best to do a quick revision after entering the data for errors.

Another mistake in the credentialing process is missing out on relevant data or completely omitting a required document. These mistakes stand out and create havoc in the process. Apart from these two, poor handling of documents also creates ambiguity and confuses the application process. It also leads to resubmissions. 

3. Inaccuracies in the Application Process

Not only do mistakes happen in data entry, but inaccuracies in the application process can also cause delays and rejection of the credentialing application. Aspects that can potentially go wrong are-   

Delays due to clinical staff: Understandably, clinical staff are super busy. Often they need to respond to queries and doubts arising in the application process.   

Incomplete application: Leaving important places blank or not attaching relevant documents often falls under the incomplete application category. It leads to confusion, and sometimes the application also gets rejected.   

Failure to track the application status: Negligence might sometimes happen from your side but can also happen from other parties involved in the credentialing process. Sometimes insurance providers might cause delays in processing the credentialing application, so clinical staff needs to keep track of the application at every stage. Failure to do so is also a mistake for the clinical staff.   

Authorization mistakes: Credentialing applications require signatures and attestations of the specific party. Any mistakes in this can lead to the rejection of the application.   

4. Mistakes in Enrollment Process

As the enrollment process is about billing and payments, any mistakes directly impact the revenue cycle. Some common incidents that are marked as mistakes are-  

Need to meet insurance providers’ criteria: Insurance companies also set credentialing regulations, including protocols, timelines, and more. Meeting these criteria can ensure the credentialing process is successful.   

Having no contacts with Insurance companies: To get credentialing done for practice or physician, it’s crucial to know the insurance companies in that area. 

5. Compliance Errors

There are different state requirements for credentialing, and staff needs to be careful about these compliance requirements. Failing to be compliant is a major issue of credentialing in healthcare. Some reasons are-   

Lack of complete knowledge: If the staff responsible for the credentialing process is ignorant of the regulations and other requirements, it can mess up the whole process.    

Lack of knowledge of the specialty: As every specialty has specifics, it’s essential to have full knowledge about the specialty being practiced. It’s crucial to prove the competency for the specialty through required documents, which ensures smooth credentialing.   

Non-compliant with specific regulations: Since every insurance company has its own set of regulations, it’s the responsibility of the practitioner or physician to ensure compliance with those specific regulations.   

Lack of legal implications: As mentioned before, credentialing mistakes can lead to legal consequences. Another issue is that many staff members need to be made aware of the legal implications of credentialing, which they must have.

6. Lack of Digital Support

As the credentialing process is quite complex, doing it manually is an uphill task. Opting for digital support like credentialing software can make the process faster and less complicated. The staff handling the credentialing process can only sometimes be updated with state and private companies’ regulations if done manually.   
Moreover, staff might miss deadlines, considering they have other administrative chores. Plus, they can’t track the application as well. These can result in severe consequences, as you can imagine. Getting credentials is a task; renewing them before they expire is another job. As mentioned, clinical staff have a busy schedule, and forgetting the renewal dates is quite possible. In all these expected complexities of the credentialing process, deploying software can make staff’s job a lot easier. 

Challenges in Healthcare Credentialing Software

Implementing healthcare credentialing software can be challenging owing to some specific roadblocks. As medical credentialing is a complex process, deploying credentialing software can make the process a breeze. However, facilities, physicians, and developers still have some obstacles in the implementation process- 

1. Lack of Privacy and Security

Ensuring the practice’s background is essential for the healthcare credentialing system. Not just of the health practice but also the independent applicant. If background checking is not done, important information regarding malpractice, board actions, or other reports may remain undisclosed to NPD. Securing and keeping this information private is important for credentialing and insurance organizations.

2. Ensuring Compliance with State Regulations

Implementing credentialing software can be affected due to constantly changing state regulations. As every state updates its credentialing regulations, keeping tabs on this is important to ensure compliance when deploying the software.

3. Inability to Access Updated Information

In medical staff credentialing software, up-to-date information is a must. Without having access to up-to-date information can make the implementation process more complex or delay it. The healthcare practice must provide developers with updated information to ensure smooth implementation. 

4. Inability to Switch Platforms

Credentialing in healthcare platforms can require integrations with more needs. Integrations with other platforms can easily cater to practitioners’ varied needs. However, integration or migration won’t only be possible if the platform lacks content compliant with regulations. This can affect the custom healthcare credentialing software in the long run.

5. Unable to Meet Deadlines

Meeting deadlines is a must in the medical credentialing process. The inability to meet deadlines can cost healthcare practice significantly. Deploying the healthcare credentialing software with a reminder feature can only resolve this problem and ensure seamless credentialing.

Implementation and Adoption of Healthcare Credentialing Software

The implementation and adoption of healthcare credentialing software can be a complex process. There are several steps involved to ensure the successful implementation of the software, such as:

1. Determining Organizational Needs and Choosing the Right Software

Before implementing healthcare credentialing software, healthcare organizations should determine their exact needs and requirements. This includes understanding the scope of the credentialing process, identifying the key stakeholders, and deciding the budget and resources.

2. Planning and Executing Implementation

Implementing healthcare software can be a challenging process so having a clear plan is very important. There must be an implementation team that decides the timeline and milestones and comes up with a communication plan. The team should also ensure that the software is properly configured and that the software is integrated with other systems as required.

3. Training and Support for Users

Users should be trained on how to use the software effectively. They should know the ins and outs of the software’s features and functionalities to ensure the successful adoption of the software. This also includes providing training sessions on the best practices to use the software.

How Much Does Credentialing Software Cost?

The cost of credentialing software can vary greatly, depending on the different functionalities that your organization needs. The basic packages may range from $500 to $750 per month, while more advanced solutions cost anywhere from several hundred dollars to several thousand per month. The costs of implementation can also differ, particularly between hosted and in-house solutions, where platform fees may be added to your monthly license fee in hosted solutions. Lastly, setup and custom development may result in certain additional expenses.

How to Choose the Right Credentialing Software for Your Organization

There are several credentialing software systems available in the market currently that include the basic features like data storage and online verification. However, if you wish to make your organizations’ credentialing process more effective and proficient, look for credentialing software that includes the 10 features listed below.

1. Centralized Credentialing

Centralized credentialing is a process whereby two or more healthcare facilities reduce costs by dividing the total cost of credentialing providers. The good news for providers is they only have to go through the lengthy credentialing process once. This also increases the goodwill between providers and administrators. Other advantages of centralized credentialing include enhanced credentialing efficiency, easier facilitation of delegation with payers, and improved data integrity, all of which boost revenue cycle management.

2. Cloud-based System (Total Portability)

Portability will not be an issue if you opt for a credentialing software solution that saves the data on the cloud. This will ensure that all the users – your organization’s employees and the providers – can use the credentialing system on any digital device with complete security.

3. CAQH Integration

The Council for Affordable Quality Healthcare (CAQH) is a non-profit association of health insurers that collects and maintains a database of provider credentialing data. A customized credentialing system integrated with provider credentialing information from CAQH will make it easier to share provider data accurately and efficiently with multiple health plans in one go.

4. Workflow Automation

The credentialing process involves the collection of data from the healthcare providers, development of the credentialing strategy, verification of the given credentials and licenses, management of provider profiles, and getting in touch with payers. Credentialing software tailor-made with real-time, intuitive dashboards, and automated workflows for online verification, attestation aging, expiration management, credentialing metrics, and onboarding options will considerably enhance productivity.

5. Document Expiration Management (Alerts and Reminders)

Healthcare facilities using manual credentialing face challenges in regularly updating providers’ data and credentials. However, credentialing software built according to your requirements can help to keep track of the provider’s profile as well as documents and certificates nearing expiration and changes in performance metrics. You can also configure expiration reminders and alerts to send automatic notifications and email reminders to the staff responsible for these tasks.

6. CME Tracking (continuing medical education)

Learning never ends for physicians and other health professionals who are committed to improving patient care. However, tracking continuing medical education (CME) activities can get very tricky. When choosing credentialing software, look for a system that offers professionals a streamlined process to earn, track and view reports on CME certifications, CME credits, and certification points.

7. Electronic Forms and e-Signatures

In a medical facility, every second counts, and sometimes, waiting for certain medical consent forms or signatures can prove to be costly. Credentialing software solutions with comprehensive and robust systems that allow for the use of electronic forms and e-signatures can greatly benefit healthcare professionals.

8. Peer Review Process Automation

Medical peer review is a measure used to improve the quality and safety of patient care. In this process, healthcare professionals evaluate the performance of current and former colleagues to ascertain the accuracy, relevance, and significance of their work. If the credentialing software system acquires, combines, and saves feedback for the provider obtained from peers, this will help the peer review process run smoothly.

9. Secure Database Management

We all know how important data is, and yet, if not managed efficiently, the same data can pose a big problem. In manual credentialing, healthcare facilities struggle with handling providers’ data. A personalized credentialing software system with comprehensive end-to-end functionality takes care of all aspects of data management such as data storage, data segmentation, and data security.

10. Customized Reporting

With automated credentialing, you no longer need to rack your brains, creating different reports to figure out how each parameter impacts the workflow process.  Intuitive, comprehensive, and customized credentialing reports available in credentialing software systems use an ad-hoc report writer to recover insightful data and customize reports with top-quality features including institutional summary, days in enrollment, facility summary, provider summary, etc.

Conclusion

Every year, healthcare facilities spend a considerable amount of time and money on provider credentialing. A healthcare facility’s complete revenue cycle depends on proper medical credentialing. Any errors in insurance credentialing will cost you valuable time and money in addition to increased legal liability, and coverage and referral issues. Invest in a customized credentialing software solution to streamline this expensive, time-consuming, and complex process and boost your organization’s income and efficacy.

OSP can program a custom-made healthcare credentialing solution to help you credential smarter and faster. We have experience in building top-notch credentialing solutions that can eliminate administrative paperwork and replace it with a simplified credentialing solution. Learn how we helped a mental health provider in Texas to solve their credentialing challenges here.

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