How To Overcome The Challenges In Medical Credentialing?

Medical credentialing is one of the most important compliance issues in medical practice today. It is a time-consuming task and a complicated process to do it correctly. If not done accurately, the medical practices will result in the loss in their valuable time and money. A poor medical credentialing system may not only lead to enrollment issues but it also leads to legal and financial complications. Do you know what drops down the medical credentialing process? Here are the top most common 4 medical credentialing challenges every practice should be aware of and the solution – how to overcome those challenges in the credentialing process.

What is Medical Credentialing?

Medical credentialing is a process of verifying and assessing the health provider’s qualifications, including education qualification, career history, training experience, residency and licenses specialty certificates (if any) and other qualification details.


Challenges in Medical credentialing

1. Lack of Staff for verifying credentials.

The medical credentialing process requires an expert team or organization to every individual healthcare provider’s credentials who provide services for patients. Do you know whose credentials should be verified? The list includes doctors, nurses, physicians, assistants, therapists, and every other provider. For each of these individuals their entire educational qualifications, employment history, training certificates, residency, and licenses, as well as any certifications issued by a board in the provider’s area of specialty should be verified carefully. So this huge process will take a lot of teamwork to handle in a correct way without any kind of errors.

This is the common mistake made by some practices – not allocating adequate resources or staff to complete the medical credentialing process. This results in the loss of revenue and creates work stress of the available limited staff. When staff makes mistakes on applications, and the applications are not accepted by the insurance provider, it delays the reimbursement process.

What’s the solution?

Outsourcing the Medical credentialing process to the top 10 medical billing service providers will help you to overcome this challenge easily. Because a well-reputed organization holds the expert administrators and staff for the credentialing process. So the team will handle everything in a smooth way without any errors and complete on time which can save your practice’s precious time and money.

2.Incomplete provider enrollment applications

The provider enrolment applications are the key to the successful completion of the medical credentialing process. So it should be done in the correct way with all the necessary information. Some practices may fail to do it accurately without missing any data fields which delays in reimbursement and potentially denied claims.

What’s the solution?

The human-made errors are common while working on provider enrolment applications. In order to avoid these kinds of errors, advanced credentialing based software will help you to do it in the right way. This automated process usually requires only less administrative effort – eliminates the human-made errors which save your time, money, and resources.

3.Maintaining up to date information

Accessing applicant information is a major challenge for healthcare organizations. A good medical credentialing process ensures that a healthcare provider is up to date with their board certifications and licenses. This means, all the healthcare providers need to renew their licenses and credentials regularly and keep it up to date. Around 85% of credentialing applications have inaccurate, missing, or out-of-date information. Very small changes, like an address or phone number, must be re-attested in the CAQH database before an application can be processed by the system.

What’s the solution?

Having physician contact information and other related data to be readily available will help you to speed up the credentialing process tremendously. Re-credentialing will also take a long time to process. This act will also reduce this kind of credentialing issues.

4.Meeting Deadlines

The medical credentialing process plays a major role in your healthcare organization’s revenue cycle. In the overall process, the review of the applications alone will take up to 90 days for an organization. When considering the additional stakeholders like insurance providers – the processing can actually take up to six months — which further stalls your organization.

What is the solution?

By considering safety as the first priority, assume the maximum amount of time no matter what. If it takes less time, then you will be ahead of schedule.

CapMinds Medical Credentialing Services – The Right Choice to simplify your credentialing process.

What We Do?

  • Collects and reviews all necessary documentation to ensure completeness and accurateness prior to submitting to the payer
  • Relieves staff and providers of the time-consuming tasks of enrolling and re-credentialing with both government and commercial payers
  • Ensures all providers are credentialed in a timely fashion to avoid delays in payment or loss of reimbursement
  • Maintains relationships with thousands of payers across all states and manages all communication and follow-up through approval of applications
  • Works closely with our billing team to monitor any denials and communicates with payers for prompt resolution

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