The Biggest Challenge in Medical Credentialing That No One Talks About

Credentialing is evolving.

There have been monumental shifts in credentialing in the past few years. In fact, my colleague and I did an entire webinar on the evolution of credentialing earlier this year. And we spent very little time on what’s becoming the biggest challenge in credentialing. Because no one talks about it.

What Is the Biggest Challenge in Healthcare Credentialing?

Completing the credentialing process using paper, files, and faxing was so painful that everyone jumped on board when digital options became available. Most payers created their own portal, most state and federal government agencies brought documents and databases online, and tech companies did their best to streamline processes.

But, now the biggest challenge in medical credentialing is managing multiple systems. None of them share data and you’re bouncing from one portal to the next — trying to manage all the logins and duplicating data entry.

It’s like television. It started as very limited black and white TV. Now you’re likely juggling multiple streaming services. It’s clunky to move between them and downright irritating every time you have to login. 

But, the fact is, no one ever talks about going back to black and white TV. Just like no one talks about going back to a paper credentialing process.

Learn more about digital credentialing in the Secrets to Speed Up Your Credentialing Process.

The Need for Integrations, Information Sharing, and Automation

Digital credentialing is better than what we were doing 10 or 20 years ago, but there has to be more efficiency and improved processes. These will likely come through technology including integrations, APIs, better shared databases, and automation.  

Integrations

Credentialers should not have to enter the exact same information into a payer’s portal, Medicare PECOS (Provider Enrollment Chain and Ownership System), the state Medicaid system, and whatever tracking platform the healthcare organization is using. These systems should be able to seamlessly share data through open APIs (Application Programming Interface) with the appropriate security measures in place. Right now, the biggest payers and healthcare organizations are using CSV files to share information. In many cases, even that level of integration is not supported. 

Information Sharing

A secure shared database, without the ability to edit, could provide incredible efficiencies in nearly all credentialing processes, but especially in reducing the need for manual verifications. The Office of the Inspector General (OIG) is already doing this with the List of Excluded Individuals and Entities (LEIE), which eliminates the need to bounce between websites and paid databases. However, there are dozens more verifications that must still be completed by hand, which keeps providers from seeing patients and slows down the hiring process.

Automation

Credentialing is full of tedious, time-consuming processes that could be automated to free up resources for other tasks. Automations are already available for exclusions monitoring, to identify missing information, and remind of upcoming deadlines. When silos between data sources are removed and sources are standardized, automation could eventually pre-fill enrollment applications, flag discrepancies, and set up provider data collection based on specialty. Reducing the potential for human error is critical to increase accuracy and decrease costs and time required.   

The Future of Medical Credentialing

The future of medical credentialing is bright. Digitizations have been adopted as the standard and, while more cumbersome than we’d like, the process is improved from the days of paper files and faxing. Solutions are coming that will bring together the data stored in multiple online systems. These solutions to the biggest challenge in medical credentialing will not only make the process easier, but they will prevent credentialing fraud, protect patients, and save money for healthcare organizations.

Maybe if we started talking about this unspoken challenge, we could force a quicker solution.