Learn How to Master Telehealth Credentialing

Telehealth offers patients greater access to healthcare services and providers get more flexibility in their schedules. However, telehealth credentialing can be a challenge since many providers now cross state lines with different requirements and accept more types of insurance.

Let’s look at the industry’s unique credentialing process, challenges, and how telehealth practices are adopting technology to prepare for the future.

The Credentialing Process for Telehealth Providers

The credentialing process for telehealth providers is similar, if not the same, as in other care settings. The process spans various stages, including primary source verification, work history and reference checks, background checks, and payer enrollment, potentially extending up to 150 days. At a minimum, these are standard documentation requirements:

National Provider Identification (NPI) number
Current Curriculum Vitae (CV)
Copies of professional state licenses and DEA licenses
Board certification information
Professional liability insurance information
Peer and professional references
Continuing Medical Education (CME) documents

Providers or organizations must also decide which insurance companies they will accept. This initial choice can significantly impact the telehealth patient base and operational dynamics. Following this, providers embark on the enrollment phase, a prerequisite for accepting insurance and treating patients.

Many payers require providers to maintain a CAQH ProView profile. CAQH credentialing is designed to alleviate the work for providers because many major payers can access that information without the provider completing a separate application.

Common Challenges in Telehealth Credentialing

Telehealth encompasses various modalities, including real-time video conferencing, remote monitoring, mobile health apps, virtual consultations, and asynchronous communication (e.g., secure messaging or store-and-forward technologies). This versatility allows healthcare providers to tailor telehealth services to meet the specific needs of patients and clinical scenarios.

Any challenges encountered in the credentialing process can have a significant financial impact on the center when a physician cannot see patients or claims are being denied. According to Merritt Hawkins, one physician’s revenue for an organization is $9,000 per day, so even a few day’s delay can have a significant impact.

Here are some of the most common challenges in telehealth credentialing:

State Licensure Requirements: Telehealth providers must comply with licensure requirements in each state where they practice or where their patients are. Navigating the complex landscape of state licensing laws can be time-consuming and costly for organizations.
Credentialing Across Multiple Platforms: Telehealth providers may need to be credentialed and privileged within various healthcare organizations, depending on where they practice. Managing credentials across numerous platforms adds complexity to the credentialing process.
Verification of Telehealth Competencies: Credentialing organizations may lack standardized criteria for evaluating telehealth competencies, such as proficiency in using telehealth technology, communication skills in a remote setting, and adherence to telehealth best practices. Establishing and verifying these competencies can be challenging.
Quality Assurance and Peer Review: Ensuring the quality of care provided via telehealth requires mechanisms for peer review and quality assurance. Credentialing organizations may struggle to develop and implement effective peer review processes tailored to telehealth services.
Security and Compliance: Telehealth providers must adhere to strict security and compliance standards to protect patient privacy and ensure the confidentiality of medical information transmitted electronically. Credentialing organizations must verify that telehealth providers have the safeguards to comply with HIPAA and other relevant regulations.
Provider Authentication and Identity Verification: Credentialing organizations must implement robust processes for authenticating the identity of telehealth providers and verifying their credentials, licensure, and certifications. This may involve additional steps, such as biometric authentication or identity verification services, to prevent fraud and ensure patient safety.
Training and Continuing Education: Telehealth providers require specialized training and continuing education to deliver high-quality care in a remote setting. Credentialing organizations may struggle to ensure that telehealth providers receive adequate training and maintain competency in telehealth best practices over time.
Credentialing for Multidisciplinary Teams: Telehealth often involves multidisciplinary care teams, including physicians, nurses, allied health professionals, and support staff. Credentialing organizations must establish processes for credentialing and privileging each member of the telehealth team, ensuring that all providers meet the necessary qualifications and standards of care.
Rapidly Evolving Telehealth Landscape: The telehealth landscape is rapidly evolving, with new technologies, regulations, and best practices emerging regularly. Credentialing organizations must stay informed about these changes and adapt their credentialing processes accordingly to ensure that telehealth providers meet current standards of care.

Addressing these challenges head-on with strategic planning and technology can streamline telehealth credentialing, benefiting providers and patients.

Optimizing Credentialing Through Technology

Adding technology to your credentialing process offers speed and efficiency that cannot be replicated using a manual process. That’s why Infinity Business Insights predicts the global provider credentialing software market, valued at $1.3 billion in 2021, will reach $5.6 billion by 2030. Innovations that offer enhanced accessibility, scalability, and data security are in high demand as telehealth providers look for ways to streamline the credentialing workflow.

Automation

Automating tedious and time-consuming tasks such as reminding providers to submit documents and checking exclusions databases helps free up time for credentialers and reduces frustration. Leading credentialing software offers a secure online portal for providers to upload the documents required by your telehealth providers and automated email reminders that continue until completed. You can also automate reminders to stay on top of important deadlines, like re-credentialing and expiration. Automated exclusions monitoring and license verification eliminate the website hopping and waiting — again, freeing up valuable time for credentialers to spend on the tasks that require a human touch.

Workflows

With so many moving parts in the credentialing process, it is easy to miss a step or let too much time pass between steps. Credentialing software offers customizable workflows to keep your telehealth process on track so you can submit a complete credentialing packet the first time. Workflows may include a checklist with assignable tasks, reminders, and dashboards showing outstanding items and due dates.

Transparency

Without credentialing software, it is tough for leadership to have visibility into the process — or for the process to continue uninterrupted if a credentialer leaves the organization. With all documents and information in a central provider profile and all actions tracked in one cloud-based platform, anyone with access can see precisely what has been completed and what is yet to be done for each provider. Dashboards can provide this in a high-level view with the enrollment metrics needed to make business decisions.

Real-Time Reporting

The in-depth reporting included with leading credentialing software provides the insight and visibility you need to keep processes on track and share data with leadership through scheduled reports emailed regularly (daily, weekly, monthly). Every telehealth provider operates differently and prioritizes different metrics. Make sure to choose software with customizable enhanced credentialing reporting so you can select the data and filters you need, then save the reports you use most often.

By leveraging these technological advancements, the telehealth provider can enhance efficiency, reduce errors, and maintain compliance, ultimately improving patient care and operational effectiveness.

The Future of Credentialing in Telehealth

As the industry moves toward a more efficient future, the role of technology, particularly credentialing software, becomes undeniably central in optimizing operational effectiveness and enhancing patient care quality. The advent of AI to enable efficiency in credentialing processes not only promises enhanced security and accessibility but also paves the way for a more seamless healthcare delivery system. For those looking to advance their telehealth credentialing process with cutting-edge technology, explore how MedTrainer Credentialing Software can significantly reduce turnaround times and improve accuracy. This is a pivotal step toward operational excellence and unparalleled patient care.