Choosing the right credentialing specialist can be a complex and time-consuming process that sometimes takes several to properly onboard a new provider in the healthcare organization. Several challenges can arise during this process which causes delays in onboarding as well as revenue losses to the medical practice.
Let’s discuss the potential challenges in implementing professional credentialing services and what strategies can prevent or make the process more effective.

Credentialing Issues in Healthcare

Improper credentialing can negatively affect your healthcare organization as well as providers. Let’s look at some of the potential challenges you can face in implementing healthcare credentialing:

1. Delays and Lost Revenue

Medical and insurance credentialing takes anywhere from 90 to 120 days. Any delays in documentation submission and approvals cause losses to both the provider and the organization.

2. Data Integrity Problems

Errors in paperwork such as spelling or missing information and not validating information can cause rejection. If this occurs, then new paperwork needs to be resubmitted and go through the approval process again.

3. Non-Compliance

Any violation of federal or state regulations can lead to fines and credentialing delays. Furthermore, this can eventually lead to your application being rejected by the credentialing board.

4. Unprotected Private Information

Any information breach or leak of the provider’s private details can become concerning for the organization and the provider.

5. Inadequate Credentialing Knowledge

Unqualified staff or individuals can make the credentialing process slow and the losses in revenue that affect both the provider as well as the medical practice

Strategies to Prevent Healthcare Credentialing Challenges

Healthcare credentialing specialist can solve these issues with strategies that can prevent delays and losses, making the process more effective.

1. Partner with a Credentialing Service

Outsourcing credentialing to a trusted third-party service can help make the process more efficient with the right professional guidance. This saves time and money as well as effective completion of credentialing and enrolments.

2. Hire and Retain Qualified Staff

Hiring and retaining qualified is important for making the credentialing process easy and productive. With several months of training, staff become more efficient in credentialing processes, and being updated on new policies allows for more approvals.

3. Use Automated Services

Automating your credentialing can prevent data errors and optimize processes. With the verification of state and federal licenses and third-party services, CAQH credentialing makes the process more effective by sharing provider information with multiple insurance and health networks.

4. Collaborate with Leadership

Collaborating with organizational leadership and keeping them informed on updates can improve your onboarding and any credentialing issue in medical billing. This allows for data-driven decisions for a better approach.

5. Understand State and Federal Regulations

Understanding state and federal laws and regulations is important for reviewing licensing, insurance billing, and Centers for Medicare and Medicaid Services requirements. Better knowledge of these laws and regulations can increase approval rates.

6. Track and Record Progress

Using tools like checklists, logs, and provider enrolment guides for tracking credentialing information and progress to prevent delays.

7. Start Early

The credentialing process can be time-consuming, so start with a pre-application submission to know any errors that can cause delays and fill out any missing details with copies of documentation.

Overcome Credentialing Challenges with Precision Hub

While healthcare credentialing can be a challenging process, it doesn’t have to cause problems for provider onboarding. Credentialing specialist makes the process easier by offering features such as complete provider profiles, automated license verification, and a reliable enrolment workflow.