Exploring Web-based Credentialing for Physicians & Staff

By Matthew Haddad
 
Healthcare providers today face more challenges than ever before. Being a provider is no longer just about offering the best care to your patients; now providers have to spend equal time on new administrative burdens like choosing an EHR solution, converting to ICD-10, and keeping processes, procedures, and technology compliant with constantly changing industry regulations.
 
With this expansion of responsibility, many providers have begun to look for tools and partners that can streamline the most complex and time-consuming administrative requirements so that they can finally get back to what they’re meant to do: care for patients.
 
Current credentialing challenges
 
In a search for the largest challenge that providers and their staff face, one candidate for simplification immediately rises to the top: credentialing. In a 2010 study, the Medical Group Management Association (MGMA) found that nearly 30% of healthcare providers find the credentialing process to be a “considerable or extreme challenge” and credentialing activities appeared twice in the top 25 list of provider grievances.
 
In order to participate with any health plan, hospital, or government health program, providers and their staff must prove their identity and their qualifications to provide required health services. This seems straightforward enough, but with the tangle of ever-changing industry regulations, required recredentialing every two to three years, and the fact that each provider must separately credential with each affiliated entity, suddenly providers are completing as many as 17 different paper applications each year and the burden becomes unbearable. Providers and staff are left to drown in the paperwork of so many applications, wasting time writing, copying, and submitting the same information every credentialing cycle.
 
Electronic credentialing: the wave of the future
 
With the advent of Web services and other software innovations, the area of credentialing has experienced a dramatic renaissance in the past decade. Discerning providers are now taking the first true step toward credentialing efficiency by utilizing the services of credentialing organizations that offer technology to simplify and speed up the credentialing process.
 
The most significant improvement these partners offer is an online credentialing application, as exemplified by products such as ProviderSource™ or UPD®. Now, instead of submitting those paper applications by hand, providers can enter their information once into a secure, online application that affiliated entities can then access during each credentialing cycle.
 
While the online application is undeniably useful, many providers still find the credentialing process to be arduous. For this reason, forward-thinking providers have recently begun to explore the services of a select group of credentialing organizations that have taken the next step.
 
In addition to a simple online application, these cutting-edge partners are now offering providers comprehensive credentialing assistance services – allowing for providers to relax as these trusted organizations monitor, update, and even submit credentialing information and applications on behalf of the provider. Offering clear dashboard views of every affiliation and their credentialing requirements, upcoming credentialing events, and online application submission and tracking, providers can now access a complete and transparent record of every credentialing activity while avoiding the hassle of the industry’s standard do-it-yourself model.
 
Continuous credentialing ensures provider success
 
In addition to the online application and tracking, another component of electronic credentialing is real-time information verification and data updating. Accomplished through patented technology, affiliated entities are now utilizing credentialing partners to automatically and electronically verify provider information on an increasingly continuous basis.
 
No longer are organizations waiting 2-3 years to recredential a provider; instead, they are verifying information in real time, and immediately taking action on any information discrepancy. So how does a provider adjust to this constant credentials monitoring?
 
To ensure smooth and continued provider participation with all affiliations, some credentialing organizations are now offering the benefits of real-time verification technology to providers. Through the services of select credentialing partners, providers can receive notifications of when expiring credentials (e.g., licensure, DEA registration, etc.) need to be renewed and when it’s time to re-attest to the application.
 
Some credentialing organizations even offer exclusive services to providers which allow automatic retrieval of expiring credentials directly from primary sources and updating of the provider’s corresponding credentials application — all without the provider doing anything. With experience on both sides of the credentialing paradigm, these partners can immediately simplify each provider’s credentialing activities while ensuring unparalleled quality assurance and uninterrupted participation with every affiliated entity.
 
With this assurance and the help of the right credentialing partner, every provider and their staff can finally give patients the time and attention they deserve and leave the obligations of credentialing to a trusted partner.
 
Matthew Haddad, J.D., is president and CEO of Medversant Technologies, LLC. As a health care industry consultant, Mr. Haddad has arranged financing and provided interim management to acute care facilities, skilled nursing facilities, psychiatric care facilities and assisted living centers. He is also a patent holder of Medversant’s AutoVerifi™ technology (US Patent No. 7,529,682).