Tips To Streamline Multi-State Credentialing

A healthcare credentialer’s task list to enroll a single provider with one payer is 10 steps long and can take months. Many, if not most, payers are state-specific, so when completing multi-state credentialing, you’re multiplying the workload — and complexity. Even if the payer has the same name, like BlueCross BlueShield, the enrollment requirements are likely different across state lines. Nothing is easy!

Growth of the Interstate Medical Licensure Compact (IIMLC) has led to more providers being licensed in multiple states. In fact, physicians using the Compact obtained an average of four licenses each. So, it’s natural that credentialers are now looking for ways to streamline multi-state credentialing. Keep reading for multi-site and multi-state credentialing tips to improve your processes.

Challenges in Multi-State Credentialing

Managing the credentialing process across multiple states presents a unique set of challenges for healthcare organizations. Here are some key obstacles:

• Multi-Site Tracking: Without credentialing software, it is nearly impossible for leaders to see status or progress, especially across multiple sites. The files live separately in each location, tracking isn’t centralized or standardized, and there are constantly questions about where a provider is in the process. Don’t let confidentiality concerns stop you from bringing all locations into a single system. Choose a system with role-based access and permissions.
• Varying Requirements: Credentialing and enrollment processes can differ significantly from state to state, making errors and miscommunication common. This magnifies the need for standard processes. A greater volume of enrollments brings more change, and failing to update credentialers on these shifts can result in inaccurate information and delays.
• Lengthy Procedures: Handling multiple lengthy credentialing processes simultaneously can be overwhelming and time-consuming. Timelines may vary by state and result in overlapping credentialing task burdens. Differing state procedures can impact credentialers’ time management processes.
• Siloed Workflows: If you have multiple sites or providers licensed in multiple states, you likely have more than one person on staff who touches parts of the credentialing process. Credentialing delays aren’t caused by the work itself, they’re caused by the handoffs. Watch this on-demand webinar to see why credentialing and enrollment need to work as one.
• Communication Barriers: Building and maintaining relationships with payers in multiple states is necessary as your organization grows, but it is challenging. Time differences may impact how credentialers connect with payers at their convenience. Trusting relationships don’t form overnight, so credentialers must spend valuable time building rapport to expedite enrollment applications.

Five Tips To Streamline Multi-State Provider Credentialing

1. Centralize Credentialing Documents

• • Create a standardized list of mandatory documents for each payer to ensure all necessary paperwork is collected.
  • Store all credentialing documents electronically to facilitate easy access, retrieval, and sharing across different locations. This reduces the risk of lost or misplaced documents and enhances the overall efficiency of the credentialing process

2. Standardize Credentialing Processes

• • Develop and implement standardized credentialing workflows that can be applied across all sites and states. This will ensure consistency and reduce variability in the credentialing process.
  • Record training on the process and upload to your healthcare learning management system so involved staff can follow the standardized procedures.

3. Enable Shared Workflows

1. • Use an access-based digital system so corporate teams can see each site individually and provide support when a site is falling behind or has credentialing staff turnover.
   • Leverage a single workforce compliance platform so credentialing staff can complete their tasks, compliance officers can pull audit-ready documentation without asking, and executives can see status without a meeting.

4. Automate Redundant Processes

• • Eliminate the time-consuming process of monthly checking every federal and state exclusion database. Automated exclusions monitoring can save hours!
  • Identify other repetitive tasks in the credentialing process that can be automated, such as application tracking, reminders for license renewal, and document verification.

5. Improve Tracking and Visibility

1. • Simplify multi-site tracking with technology that offers a full organizational view, as well as the ability to see data by location. This is really hard to do without software.
   • Look for automated tracking and centralized dashboards or reporting tools to monitor the progress and status of credentialing tasks across multiple sites in real-time. This allows for quick identification and resolution of any issues that may arise.

Reduce Claim Denials With Credentialing and Enrollment Improvements

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Make Multi-State Credentialing Easier With Software 

Managing multi-state credentialing is a challenge for the most seasoned credentialer. Healthcare credentialing software accelerates the entire process by supporting shared workflows, simplifying multi-site tracking, and automating tasks. Specify mandatory documents and set up customizable workflows for each payer and state where you’re credentialing a provider. Reduce delays with automated handoffs between tasks and teams. Get visibility across the entire organization, and broken down by location.

MedTrainer offers cloud-based credentialing software that saves you time and accelerates the multi-state credentialing process.