Common Challenges in Medical Credentialing and How to Overcome Them

Medical credentialing is a necessity for healthcare providers of all sizes today as patients now demand the acceptance of insurance as a payment from healthcare providers. In order to keep a practice run successfully and offer the highest quality of care and satisfaction to patients, more healthcare providers are getting credentialed. 

But, getting on insurance panels or credentialed is not any easy process by any means. In 2023, healthcare or medical credentialing is expected to become more complex with the enforcement of new regulations to ensure quality healthcare and safety. 

This article discusses the most common challenges of medical credentialing and their solutions you may need to take a note on. 

Keeping up-to-date information

Healthcare providers should keep their information up-to-date which includes their education, qualifications, specializations, certifications, licenses, and career records. Reports suggest about 85% of credentialing approval requests entail outdated, incorrect or missing information. Even a piece of incorrect information such as address or phone number can delay the credentialing process.

Solution: 

The healthcare providers must get their information and credentials updated and checked by a professional several times, start to finish to ensure all the information and documents provided for credentialing are correct and updated. 

Lack of credentialing staff 

Medical credentialing is not a one-man task. It requires a team as the list of people who need to be credentialed may include doctors, nurses, therapists, and other staff members. Not having enough resources and staff can make this process lengthy and increase the approval time. 

Solution:

Outsourcing medical credentialing to a well-reputed service provider can alleviate the load as well as make sure all credentials are carefully checked and are ready to be submitted for approval. 

Time-consuming 

Medical credentialing is a time-taking process and involves multiple stages/phases to finally get credentialed. The application review itself may take upto 90-120 days to get complete and when there is an involvement of key stakeholders, this may also take six months. This time-consuming process can be a major roadblock for healthcare providers. 

Solution: 

Healthcare providers can reduce this time span by starting early and submitting all the correct and present information while filing for the application. One can also hire a credentialing expert who can help lessen the time of credentialing. 

Staying compliant with state regulations

Each state has different policy guidelines that healthcare providers need to follow. These rules and regulations may also keep changing from time to time and hence, it becomes crucial for providers to keep up with the changing state regulations.

Solution:

The credentialing team must keep a track of all these changes and requirements and update them accordingly on the practice management software so that a provider stays compliant with state regulations. 

Meeting the deadline

Healthcare providers must be aware that the medical credentialing application review may take 90-120 days to get processed. Additionally the insurance companies and other organizations may have their own timeline and standards and sometimes, it may take upto six months to complete the credentialing process. 

Solution: 

It is difficult to say accurately the exact time to be taken to complete the medical credentialing process. But, the use of technology and a streamlined procedure to manage credentialing can reduce errors in the application and speed up the process. 

The Bottomline

There’s no denying that the medical credentialing process is hectic and sometimes, a nightmare for most of the healthcare providers. Today, with the ever-changing healthcare industry, providers prefer outsourcing their medical credentialing process to experts. By choosing to outsource, providers can avoid the piles of paperwork, get themselves credentialed with PP0/HMO/medicaid, and check the real-time status of their application.