Keeping your healthcare professionals focused on patient care and ensuring that you get paid by insurers while navigating the complexities of regulations, accreditation, and certifications in today’s health care system can be difficult. In the medical field, credentialing is one of the most significant compliance issues, especially when working with multiple providers. Without streamlined credentialing processes, healthcare professionals are more prone to errors in oversight, data integrity, and omissions that can result in delays, enrollment issues, and legal and financial complications. Two of the most common mistakes in the process include incomplete credentials and compromised privacy — both of which are critical in compliance in the medical industry. These errors and mistakes can lead to the loss of a professional’s license and negatively impact an organization’s esteem and reputation.

To help you better understand the credentialing landscape, we’ve put together the most common challenges healthcare workers come across during the credentialing process. Keep in mind that a fully managed SaaS credentialing solution can eliminate most of those challenges.

1. Qualified Credentialing Staff

In today’s hyper-competitive employment environment, it is becoming increasingly challenging to identify, retain, and train qualified staff to do initial and continuous credentialing. Credentialing is one of the most labor-intensive areas in the healthcare industry and is the most important step to any organization’s success. As such, finding staff that can get the job done in an efficient and productive manner is more critical than ever before. A credentialing specialist needs to navigate a myriad of systems, tools, and processes, which takes a significant amount of time and energy. Nowadays, many healthcare organizations are looking for knowledgeable and skilled specialists who can understand the complexities of credentialing as well as ensure the accuracy of all the details and information provided.

2. It’s All About The Data

The amount and variety of data required in the credentialing process are staggering. Over the past decade, many insurance providers, government regulators, and non-government organizations have engaged with healthcare organizations, adding to the volume of data that is collected and retained in the credentialing process. Nowadays, a major challenge for those in the healthcare field is collecting, assessing, and maintaining this huge volume of data. Organizations that manually process their data can have up to an 85% error rate due to human errors and oversights. Simple things such as dates, names, and locations can be incorrect or missing, leading to significant delays in processing and achieving accreditation, insurance provisioning, and payments. Having the right tools and the right team to tackle this simple but complex issue is essential to an organization’s credentialing success.

3. Meeting Deadlines

More often than not, credentialing poses an obstruction to a healthcare company’s revenue cycle due to its lengthy and labor-intensive process. For most companies, it can take up to 90 days to process an application review. However, because the credentialing process involves many stakeholders — like insurance companies, healthcare providers, and contract negotiators — the whole process can actually take a minimum of at least 6 months. This extensive process is drawn out, even more, when the credentialing is done manually as it is more prone to mistakes, which can further hamper the efficiency and productivity of the healthcare organization.

4. Inability to Change Platforms

As your business grows, so do your credentialing processes. Many companies work with a variety of different providers, many of which have their own individual requirements for credentialing. When these requirements become more complex and elaborate, organizations may need to build and add to their technology stacks or switch technology platforms completely. The problem here lies in the fact that if a company has a lot of content on its existing platforms, such as preset questions and prompts, migration and change can become impractical and complicated — especially if the content is not standard-complaint. Because of this, many healthcare companies can get stuck with an outdated platform that inhibits the efficiency of their credentialing processes.

5. Compliance at Every Turn

Provider credentialing standards, requirements, and policy guidelines vary in every state and in every organization. This makes the credentialing process more difficult due to the diverse range of compliance issues. If your credentialing process cannot keep up with the ever-changing regulations and requirements as they occur in real-time, you become more susceptible to fines and penalties. Your organization must regularly review and communicate with the various databases, such as the National Practitioner Database, to ensure that your information, guidelines, and processes are secure and up-to-date.

Medical forms to sign

6. Privacy and Security

In addition to eligibility checks, one of the most critical aspects of the credentialing process is background checks. Running background checks guarantees that each candidate abides by the national licensing requirements. Organizations must make sure that all information regarding prospective candidates and applicants is private, confidential, and secure. If information is leaked, the organization can be subject to hefty fines and sanctions.  Background Investigation companies can simplify the process by integrating tightly with your tools and processes.

7.  Overly Complicated Toolset

As with any complex process or workflow, there are multiple tools involved in the credentialing process. Credentialing specialists typically need to bounce between multiple tools to manage their email and other communication channels with their providers. However, using too many platforms and tools can result in miscommunication and delays due to confusion on the specialist’s end. It is important to try to reduce the number of tools and platforms used during the process to lessen the complexity and error margins of the team. Keeping your specialist on a single screen — and central platform — is critical to credentialing success, productivity, and efficiency.

8.  Convoluted Processes

Tools and processes go hand and hand. When looking at the credentialing process, there are multiple steps and tasks that need to be completed simultaneously to achieve an efficient outcome as soon as possible. To achieve maximum productivity, you need to be able to streamline your processes and leverage the appropriate tools that ensure nothing is missed and that every detail is captured. Missing the smallest bit of information and detail can cause significant delays when getting the provider credentialed and can ultimately cause compensation fees.

9.  It’s All In The Details

Credentialing requires a significant amount of personal data and information about a candidate’s background experience and professional credentials. All of this data is very specific and must be correct each and every time. To credential in an efficient and timely manner, a specialist must have all the tools to achieve accurate and specific results. A missing birth date or an incorrect date on any of the credentialing documents can lead to significant delays in the production process. Although the traditional credentialing process can take anywhere between 60 to 120 days, having the right information tools and resources can dramatically reduce this timeframe.

10.  The Right Partners

Efficient credentialing is not only about getting good tools but it’s also about having great people and solid processes. Finding the right partner is a critical step in credentialing success. Good partners can help you solve many of the problems and complexities healthcare agencies encounter during the credentialing process. A great partner will provide you with the right technology, tools, and industry insight to help you achieve success. Not only that but the right partner will be able to understand the unique challenges and needs of your organization to focus on the improvement of your organization’s efficiency and productivity.

The Bottom Line

Tollanis Solutions works hand in hand with Credentially to provide you with a market-leading toolset that can bring structure, efficiency, and discipline to your credentialing process. With state-of-the-art tools and processes, we can digitize every step of your credentialing journey —  from paperwork to compliance processes — to ensure that your credentialing times are reduced and your accuracy and tracking issues are minimized.