Credentialing can be a frustrating, mysterious, time-consuming process. It can seem like a black box: you throw your (copious) data in (with no idea what will happen to it), then hope you’ll get what you want out of the other side (eventually — you have no control over when). Worse, unlike most other administrative tasks your staff handles, credentialing has seemed immune to process improvement.
It’s no wonder so many practices outsource this tedious, unpredictable paper-pushing. But that can lead to another set of problems. For example, when delays occur, how do you know whether there’s a problem with the application, the payer is just slow, or your credentialing service dropped the ball at some point? Constantly checking in with a credentialing service for updates wastes valuable time on both sides — especially since your credentialing service has no more control over how long it takes payers to respond than you do.
Thankfully, dear reader, you and I are not the only people who’ve observed the built-in productivity drains in credentialing the old-fashioned way. In recent years, technology whizzes have stepped in to improve the process. There are still frustrating pieces of the puzzle that technology can’t yet fix — like the need for physicians to gather all that information in the first place, and like the uncertainty about where submitted applications stand with payers. But technology can help with:
- maintaining a single source of credentials — to avoid submitting out-of-date information or incomplete information
- tracking key dates
- enabling physicians to enter their own information via a portal — to avoid double entry of data, and the associated costs and errors
- automating the completion of many forms
- in some cases, automatically updating or communicating electronically with important third parties like CAQH
If you are not yet using a credentialing software product, now is the time to check your options out. And if you’re outsourcing, it may be more efficient to bring the task back in house, supported by up-to-date software. Or if you continue to use a credentialing service, be sure that your partner uses a cloud-based system that you can log into and get updates when you need them. (This helps reduce costly calling and emailing your service for updates.)
My partners and I here at Capko & Morgan have been reviewing options for our clients, and we’ve seen a few that we think practices should check out*:
Already using a credentialing software system that you like? Be sure you are current on all the latest features, and are using them to the fullest. It’s easy to fall out of step with best practices, since today’s software solutions are updated so frequently. Make a note to check with your vendors in January and schedule a refresher training session for yourself and your team.
Need help choosing a system? We can help you put the candidates through their paces and make an informed decision! Ask us for more information about how we help practices choose tech solutions.
* If you are a software vendor and you think you should be on this list, please contact me to share a demo.