Credentialing Pains in a Management Service Organization

Credentialing Concerns Facing Your Management Service Organization

The process of verifying and assessing provider qualifications is called credentialing. This process involves checking education backgrounds, career history, and training experience. Background checks can often include residency tenure, licenses, specialty certifications, and other requirements. The whole credentialing process can take time to finalize, greatly affecting the overall productivity of a practice in acquiring providers. Learn the top concerns that affect management service organizations involved in provider credentialing, including the following:

Lack of Manpower for Credential Processing

The provider credentialing process requires a team of experts who can competently verify all submitted documents. A well-staffed credentialing group or organization, when trained correctly, can easily process the credentials of every healthcare provider. Healthcare providers include doctors, nurses, assistants, therapists, and even interns. Each credentialing application requires careful verification and authentication of all submitted documents. These documents can include copies of educational attainment, career accomplishments, training certificates, and other required documentation. The scope of credentialing can be wide and encompassing, making delays inevitable. The entire credentialing process will often require a lot of resource utilization to complete without erroneous results.

Generally, a management service organization engaged in provider credentialing falls Management Service Organization Aid Physicians' Practice prey to understaffing problems. More often than not, this results in revenue loss while also causing avoidable stress to the employees. Understaffed employees can become affected by stress, leading them to make credentialing application mistakes. Applications with erroneous entries are unacceptable, delaying the whole process even more.

Incomplete or Erroneous Provider Enrollment Applications

This credentialing concern is usually related to understaffing problems, but can also be caused by inadequate training. Complete and correct provider enrollment applications are key in facilitating successful credentialing activities. Practices with limited manpower or ill-equipped employees generally encounter credentialing delays. A management service organization that has one or both of these factors in play can incur recurring revenue losses. Most organizations engaged in credentialing agree that an adequate number of trained employees are contributing factors to success. 

Outdated but Relevant Information

Applicant information access is a major hurdle for many healthcare organizations. Good credentialing processing ensures that healthcare provider records are updated with supporting documentation. These documents include academic and career history information as well as current licenses and certifications. Majority of credentialing applications have outdated, incomplete, or inaccurate information. This means that credentialing turnaround times are highly problematic, time consuming, and financially harmful. Minor but essential information, such as contact details, can be easily rejected if entries are erroneous or empty.

Delays in Deadlines

As with any business, a management service organization can suffer from revenue loss due to lapsed deadlines. When credentialing applications hit delays due to slow processing or erroneous entries, the repercussions can be financially detrimental. Typically, credentialing applications take up to 90 days to review and process. The length of processing time remains the same whether the application is approved or denied. Any delays caused by avoidable factors can eventually cause organizations to function ineffectively.



Resolve Your Administrative Healthcare Credentialing Problems

As a management service organization, it can be difficult to overcome certain issues that are beyond your control. Fortunately, credentialing is not one of them. Your credentialing concerns can be easily resolved when you apply one or more of the following methods:

Outsource Your Credentialing Solutions

Your credentialing process can be outsourced in two ways: outsourced manpower or outsourced software solutions. Manpower outsourcing can help your business, although this also entails heightened security risks and increased costs. However, through this method your business can function better without additional manpower and required training.

The second solution is to use integrated software solutions to manage your in-house credentialing system. This gives you better control over data security and management, although you may have to anticipate employee training. A good healthcare solutions provider will help you with manpower training to quickly integrate your business operations smoothly.

Streamline Your Credentialing Application System

Human errors can be prevented when your credentialing application process is structured well. Look for an efficient healthcare software that guides your employees to navigate through the whole credentialing process. An automated credentialing system ensures that your business can function incredibly well with lesser administrative effort. Even better, a well-developed credentialing software prevents your employees from making costly mistakes such as incomplete or inaccurate data. This equates to larger savings in terms of time, money, and operational costs.

Update All Critical Informational Requirements

Having an updated healthcare provider data ensures that your credentialing application system encounters fewer complications. This also speeds up the credentialing process tremendously, allowing you to experience quicker turnaround times with lower rejection rates. As a management service organization, your business enjoys better efficiency and makes you more enticing to clients.

Cut Down Delays

Once you have addressed the first three issues, your incidences of credentialing application delays are greatly reduced. Your business can still assume the same maximum amount of time in processing credentialing applications. However, with the right healthcare credentialing solutions, your chances of getting ahead of schedule are highly increased.

Maximize Credentialing Applications with Technology

Credentialing is an essential component in the healthcare industry. Your management service organization depends highly on how well you can help process credentialing applications. As a healthcare investment, your priority now shifts to looking for the right healthcare solutions to integrate into your business operations.

As an ardent supporter of healthcare organizations, MedVision is intent on empowering businesses such as yours. With this goal in mind, the QuickCap 7 (QC7) was developed to streamline the processes your management service organization handles. Aside from facilitating automated seamless credentialing processes, QC7 expertly manages all aspects of administrative healthcare operations, including, but are not limited to:

• Member eligibility reviews through rigorous review processes for approvals or denials
• Health plan management and patient care monitoring for better health outcomes
• Patient care coordination and healthcare delivery using integrated communication platforms
• Complete claims management and adjudication from start to finish
• Secure data management with constant encryption updates

QC7 is your customizable and intuitive administrative healthcare solutions designed to integrate seamlessly with your business operations. Powerful interdisciplinary and interoperational applications allow you to complete all your essential healthcare-related management. With QC7, you can experience unparalleled support and empowered business solutions that take your business to the next level.



Discover how QuickCap maximizes your operations.

References:

1. Patel, Roshan, and Sandeep Sharma. “Credentialing - StatPearls - NCBI Bookshelf.” Credentialing - StatPearls - NCBI Bookshelf. www.ncbi.nlm.nih.gov, October 30, 2021. https://www.ncbi.nlm.nih.gov/books/NBK519504/.

2. Track and trend behavior issues | Credentialing Resource Center. “Track and Trend Behavior Issues | Credentialing Resource Center.” credentialingresourcecenter.com, June 22, 2022. https://credentialingresourcecenter.com/articles/track-and-trend-behavior-issues.