Outsourced credentialing services offers a high-tech solution
that frees up time for your staff and minimizes errors on your processes.
What is Medical Credentialing?
Credentialing in healthcare is the process by which medical organizations verify the credentials of healthcare providers to ensure they have the required licenses, certifications, and skills to properly care for patients.
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 carriers health plan.
After verifying credentials, practitioners are credentialed and privileged – that is, the insurance carrier verifies the qualifications, education, and license initially and usually every three years.
How is Medical Staff Credentialing and Privileging Being Handled?
The credentialing and privileging process is complex, time-consuming, and detail intensive. This tedious task takes a lot of work, follow-up and tracking.
Let´s review how the process goes:
- Organizations must collect the required information from the applicant: It is the responsibility of the applicant to be 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 the act of obtaining licensing and credential information. It can be done directly from the source that issued the credentials or from a secondary source that has been given the rights 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.
- Fewer human errors: According to research, healthcare centers using software solutions saw a reduction in complaints, complications, and costs. Modio at Health Prime Credentialing allows considerable reduction in errors which used to be common in manual processes.
- Cost-effective: Nearly every healthcare center, big or small, must face budget constraints and difficulty in reducing operational costs and streamlining the processes. Implementing an outsourced credentialing solution 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.
- Quicker turnaround: Outsourcing credentialing services saves time and effort of the healthcare providers and ensures timely reimbursement. The standard time it takes for healthcare insurance carriers to verify credentials is from 60-120 days. This allows us to keep the process moving to be completed by the estimated timeline so physicians can work without any worries.
- Less paperwork/Greater security: HP Credentialing uses Modio Health to gather and store online, secure provider profiles which allows remote access with easy editing, uploading, and sharing of documents and profile data instead of using filing cabinets.
- Improved efficiency: In many healthcare organizations, the existing system consists of spreadsheets, paper documents, and checklists spread over different departments. Many of the documents need to be updated frequently, which increases the paperwork. Our system helps to verify, update and check for errors easily. Having a central database helps prevent lengthy times in setting up perimeters, storing follow up and payer status data as well as giving easy access for analytics.
Automation frees administrative staff time from manual tasks so they can 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 of time where the physician is not working or not seeing patients with certain insurances. This leads to lost income from delays that can easily be more than the cost of the credentialing outsourced service itself.
Let us know how 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 to 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 with an unbiased approach. 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 you can improve your medical practice by outsourcing your credentialing processes, feel free to reach out to us at firstname.lastname@example.org. Set up a meeting with us and discuss how we can help you get back to what matters the most: your patients.
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