Challenges to Credentialing In The Healthcare Industry


Credentialing describes the process that organizations evaluate the documents regarding a medical service provider’s training, education, work history, compliance with regulations, malpractice history, and licensure status. This is necessary to allow the provider to participate in a given network. Credentialing a provider is fundamental to the healthcare industry and is essential both clinically and financially. If any mistakes can creep inside credentialing, revenues may be lost or legal liabilities can crop up. Here are the challenges to credentialing in the healthcare industry.

Requirements are evolving
Healthcare is a continuously evolving business segment. The requirements are continuously changing and the way the healthcare organizations are managing credentialing is under constant flux. Levels of scrutiny have increased and the public reporting has become more complex, leading to the development of stringent rules and standards by the National Committee for Quality Assurance. Therefore, how the credentialing process is driven has undergone a drastic change.

Their needs have added some kind of rigor to the process in terms of requiring the organization to check the primary source with regard to diplomas, degrees, and certificates. Copies are no more sufficient to meet the requirements adequately. To ensure the accuracy and efficiency of the credentialing process, it is necessary to have people and processes that can ably address the evolving nature of the credentialing process.

The topic of resources
Organizations and payers that need to supply the required information for the credentialing process go by their own set of standards for the sake of processing the requirements. Their timelines are quite different from others. In some cases, they are much longer than we can imagine. For credentialing, it is a tough job to estimate the dates of completion. Therefore, tracking the provider progress through the process is somewhat a difficult mission.

The information needed for credentialing is no doubt readily available. However, the process still remains laborious. It calls for attention to details and a great amount of work, systematic processes and a methodical record keeping. The sophisticated software and comprehensive credentialing solutions can come to the aid of credentialing processes that will ensure that the errors are minimized and the timelines are shortened.

Additional requirements management
An organization might be in a state that requires some additional credentialing requirements. Therefore, it is necessary for the credentialing staff to stay well informed of the unique requirements in any given location. Additional steps may be sometimes necessary which can be built into the processes you implement. Sophisticated credentialing solutions address these issues by default.

Take away
The medical care industry has become highly competitive and the requirements and processes have become highly complex, especially with regard to credentialing. Amidst the changes that are taking place in the healthcare sector, some things still remain the same like the need for provider credentialing in a comprehensive fashion. Also, enrolment and privileging processes have remained the same. Rather than conducting manual verifications and filling forms by hand, it is advisable to invest in credentialing solutions that will help transform your credentialing process while saving your effort and spending in the long run.

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