Credentialing Software: Purpose, Goals, and Necessities

IN A NUTSHELL:

• Credentialing software should save time, save money, reduce risk
• Platform needs to offer secure, centralized storage
• Compliance monitoring and CME must be included

Using a credentialing software instead of manual methods such as spreadsheets is becoming increasingly common in the health care industry as medical facilities realize its benefits.

However, it is important to know what to look for in a software to make sure all of the bases are covered and there is no administrative burden for facilities or providers.

Three essential goals of credentialing software:

1. Save Time
2. Save Money
3. Reduce Risk

In order to accomplish these three items, it is important to find a platform that can handle credentialing, payor enrollment, managing provider rosters, as well as anything related to compliance and monitoring.

An all-in-one solution allows providers to begin treating patients faster which in turn increases revenue for both the facility and the provider. Consequently, health care staff can focus their time and attention on more important matters instead of administrative paperwork.

Security First:

While there are many credentialing software platforms currently available that offer basic features such as storage of digital documents and verification, only Ready Doc™ by Intiva Health has the added layer of security that comes with Hashgraph distributed ledger technology (DLT). Since Ready Doc™ is secured with DLT, providers and administrators can access credentials and other digital documents from anywhere, but still rest assured the data is encrypted at a high level of security.

Credentialing Software Must-Haves:

In addition to having a secure platform for the storage and accessibility of digital documents, an ideal credentialing software should handle as many tasks as possible to reduce burden for all parties involved:

1. Automated Payor Enrollment: Manually submitting applications for providers to payors is a time-consuming process that can create an administrative burden for staff and potentially lead to a delay in reimbursement or missing out on treating potential patients. If a provider doesn’t get paid, the facility doesn’t get paid. If the facility doesn’t accept the preferred insurance plan of a patient, they lose out on providing care for a patient and the potential to build upon their customer base. Since much of the provider data would already be stored in the credentialing platform, there is no duplication of collecting information or waiting for providers to respond to requests for information.
2. Digital Forms and Electronic Signatures: Another crucial component to credentialing software is the ability to populate digital forms with provider data and complete them with an electronic signature. This feature goes far beyond its utility for payor enrollment, as it can be used for a number of applications necessary to maintain compliance, such as license renewal. While some credentialing software solutions may have a feature to populate digital forms, it is pointless without the ability to swiftly finalize the process using an electronic signature. Many credentialing software solutions will populate an application with a provider’s information yet leave it up to the administrator to print out the document and wait for a physical signature to complete the process.

3. Compliance Monitoring: Health care sanctions monitoring ensures a facility’s providers are in good standing and not excluded from participating in any federal health care program. These checks can help a facility maintain eligibility for Medicare, Medicaid, and other federal programs. If a facility is non-compliant in accordance with federal data banks, such as the Office of Inspector (OIG) List of Excluded Individuals/Entities (LEIE) the facility could lose their eligibility to receive funding and face potential fines. It is important for your credentialing software to keep working for you after the credentialing process is complete with continuous monitoring.

4. Expiration Alerts: In addition to monitoring the providers, the dozens of credentialing documents attributed to each provider must be kept in check as well. Various licenses, malpractice insurance, and other credentials all expire at some point in time. A small lapse in renewing any of these prior to an expiration date can be extraordinarily expensive for the provider and the facility. A proper credentialing software platform provides advanced, automated expiration alerts for all expiring documents—allowing the provider and facility an ample amount of time to avoid heavy fines.

5. Continuing Medical Education: A health care provider must keep educating themselves long after they receive their degree. By continuously learning, a health care professional can provide the highest possible level of patient care, advance their career, improve the reputation of their facility, and more. A physician, nurse or other health care provider endures years of nonstop education, and the learning continues throughout their career with continuing medical education, also known as CME. These courses are essential for the growth and success of the provider and facility, yet also required for license to practice renewals. Different states have different CME requirements, and it is upon the facility/provider to track and maintain a record of the course credits. An efficient credentialing software solution will track CME credits for providers as well as offer accredited courses within the platform.

6. Centralized Task Management and Document Storage: Medical credentialing is a tedious and time-consuming process that calls for patience, precision, and attention to detail. There is a lengthy list of credential documents to verify, and the process must be repeated for every individual health care provider. This creates a significant task list for health care administrators that must be managed daily, ranging from tracking licenses that may expire, monitoring for Office of Inspector General exclusions, managing provider rosters, tracking appointments and more. With so many tasks to track at once, it is easy for human error to occur, whether that by entering incorrect information or forgetting an expiration date. And if you’re not tracking these tasks in a central location that is easy to manage and that everyone has visibility to, you’re making your life harder than it has to be, and risking compliance lapses that can have disastrous consequences. It is important to migrate away from multiple hard copy documents and folders that you may be using to manage and track individual tasks. Additionally, avoid using multiple software that are each uniquely designed to handle an individual task. Adopt a central workplace where you can store all of your digital documents and accomplish all of your tasks, from managing credentials and providers, managing privileges and appointments, to tracking OIG exclusions and expiration dates for essential licenses.

Helpful Link | Provider Credentialing Checklist (.pdf)

A secure, digital solution such as Ready Doc™ by Intiva Health offers all of the above and more. On average it takes nearly 60 days to credential a physician using manual processes and disparate, disconnected systems. Based on the average revenue a physician brings into a facility, Ready Doc™ offers a potential savings of more than $400,000 per physician each year.

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