The Secret to Improve Provider Credentialing: Reducing Backlogs

While immensely important, credentialing can often be a pesky thorn in the side of all healthcare organizations. That thorn only becomes more troublesome when credentialing backlogs occur, causing bottlenecks that ripple throughout the organization. The effects of a credentialing backlog are felt on all fronts – from disruptions in patient care and limited provider availability, to an increase in denied claims and lost revenue.

The good news is that credentialing backlogs are preventable. Avoiding them starts with understanding what’s causing the bottleneck, then implementing efficient strategies to streamline the credentialing process. With the right approach, tools, and technology, healthcare organizations can eliminate backlogs, minimize delays, and get providers back to seeing patients faster.

What Causes a Credentialing Backlog?

Let’s start from the beginning. A credentialing backlog can be triggered at almost any part of the process. For example, if the person collecting and verifying documents falls behind, then privileging and payer enrollments are also at a standstill. The process is also halted when a payer doesn’t respond to an enrollment application in a timely manner. It may even send the credentialer back to the beginning.

These inefficiencies can stem from a variety of factors such as staff shortages, high application volumes, complex verification requirements, inconsistent response times, and outdated processes that struggle to keep up with increasing demands. Manual processes, such as paper-based applications and verification, are time-consuming and error-prone. Insufficient staffing often results from underestimating the resources required for credentialing, especially during periods of high demand. Outdated systems lack the automation capabilities needed to handle the volume of applications efficiently.

A credentialing backlog at any part of the process creates a domino effect that delays provider onboarding, disrupts scheduling, and impacts patient access to care and revenue. This clearly highlights the need for modern, scalable solutions to reduce backlogs and maintain operational continuity.

Consequences of Credentialing Delays

When providers aren’t efficiently and properly credentialed, your healthcare organization is losing money and adding pressure on an already busy administrative staff. Other consequences of credentialing delays include:

Disruptions in Patient Care: When credentialing is delayed, providers cannot see patients. This can trigger longer patient wait times, rescheduling, and fewer available appointments as facilities are forced to redistribute provider workloads or even leave appointment slots unfilled.

Financial Strain: Credentialing backlogs lead to lost revenue from unbilled services and claim denials. Provider ineligibility is the second highest reason for claim denial, which creates noticeable gaps in revenue. Every day that a provider is unable to deliver services, the organization is losing $9,000 in revenue — it can add up fast!

Operational Inefficiencies: Credentialing is an intensive and time consuming task as is. Backlogs in the process only increase administrative burden, causing staff to spend more time addressing delays and managing provider inquiries. Whether you’re using an outdated system or are still tackling credentialing manually, inefficient processes divert attention from other critical tasks, creating backlogs that stack up over time.

Assessing Current Credentialing Process

The first step to improving your credentialing process is to analyze your current approach and identify the areas for improvement to help create a smoother workflow. Your assessment can look something like this:

Perform a Workflow Audit: Begin by mapping out the credentialing workflow. Identify steps prone to delays, such as verification stages or application review. Take note of how much time each step takes and pinpoint recurring bottlenecks. An initial workflow audit will help you understand what’s working and what’s not, then make adjustments as needed.

Set Clear Prioritization Criteria: Not all applications have the same level of urgency. It’s helpful to prioritize providers who are scheduled to start within a specific timeframe or those needed to address patient care gaps. Establishing a clear method of prioritization ensures critical cases move through the system faster while still completing additional applications in a timely manner.

Involve Key Stakeholders: Collaboration between compliance, human resources, and credentialing teams is essential. Start by scheduling recurring meetings to discuss any challenges and share updates. This will help open lines of communication and prevent potential bottlenecks. It’s also helpful to engage providers in the process. Ensuring they submit and complete accurate applications, for example, can prevent delays caused by missing information.

How Technology Can Help

Credentialing can be streamlined and simplified with a robust technology solution. By leveraging the right tools, like the MedTrainer credentialing platform, healthcare organizations can not only reduce backlogs but also improve the accuracy and reliability of their credentialing processes. Some features to look for in a quality credentialing platform include:

Automation: Simplify data collection and verification by automating repetitive tasks.

Automating the credentialing process—including automated license verification and exclusions monitoring—significantly shortens the time needed to gather, verify, and update provider information, expediting onboarding and maintaining compliance with minimal administrative effort.

Real-Time Data & Reporting: Dashboards and analytics tools provide the transparency you need for informed decision making. By identifying gaps and tracking application progress, organizations can quickly address issues and streamline the credentialing process. In addition, custom reports allow staff to provide status updates automatically without manual intervention or multiple systems.

Compliance Integration: The more your platforms talk to each other, the more efficient, error-free, and seamless your workflows become. Credentialing systems that integrate with broader compliance platforms can synchronize credentialing data with exclusion checks and compliance reporting, reducing duplication and ensuring accuracy.

Strategize for Efficiency

Elevating your credentialing process means creating a long-term strategy rooted in scalability and consistency. To start, evaluate your existing staff to determine if they are able to meet the expectations (here’s a handy worksheet you can use). You might find that adopting software or outsourcing credentialing tasks to third-party will help to manage high volumes of applications without overwhelming staff.

Your strategy should also include a standard process that includes clear benchmarks and guidelines for credentialing tasks. This could include setting target timelines for each step and sticking to them. It could also involve reviewing performance metrics on a regular basis. Establishing a routine helps to ensure consistency and accountability.

Finally, don’t shy away from automation! Eliminating redundant manual tasks such as exclusions checks, license verification, and recredentialing reminders can spur major time savings. Automation reduces the risk of human error and frees up staff to focus on complex cases that can’t be done through automation.

Credentialing, Simplified.

Don’t let credentialing backlogs knock your organization off course. By addressing inefficiencies, leveraging technology, and implementing proactive strategies, healthcare organizations can establish a robust and streamlined credentialing framework that adapts to changing demands and scales with your facility.

Looking to transform your organization’s credentialing process? MedTrainer has the solution. Explore how MedTrainer’s comprehensive platforms can help you overcome credentialing challenges by doing more in less time.