Medical credentialing is a lengthy process with many formalities and workflows involved. The process involves a series of steps and might take anywhere between three and six months. It requires a thorough evaluation of the application sent by the provider, for which the provider would have to submit all the necessary documentation along with his or her credentials. This is followed by verification of the practice or facility of the provider.
Subsequently, the payer’s database would be updated. It is common for providers to track their requests from time to time, and the payers need to service those requests. The payers regularly track the activities in the workflow in order to service the requests by the providers. The data of the providers is then captured to be stored for further processing and is often updated from time to time according to changes in regulation. Needless to point out, the process of tracking the documents and managing them can be challenging for payers.
That is where medical credentialing solutions can help speed up the processes. Among the most important features of credentialing software are the functions of document tracking and document management. These functions are integral for accelerating the entire credentialing process and minimizing errors in doing so. Larger the payer organization, greater the volume of provider documentation they would need to handle.
A digital interface makes it easier to perform activities like capturing prospect forms and signatures rapidly and sending them to the enrollment process. Since these activities can be completed on a digital interface without any pen or paper, coupled with automated functionality to cross-check, the result is a much faster process with no delays and fewer mistakes. Furthermore, if the solution for the medical credentialing process is HIPAA compliant (Health Insurance Portability and Accountability Act), it also takes care of any security or compliance concerns that might arise.
In addition to the issue of tracking all the documentation and essential data about the providers, payers must also ensure that there is a means of managing the documents efficiently. When managing the documents that are exchanged over the electronic data interchange, interoperability is bound to be a problem. Here again, a digital solution managing the healthcare provider credential process would go a long way in helping to circumvent any interoperability issues.
A secure cloud-based storage for handling provider data is an excellent way for payers to ensure seamless workflows in the credentialing process. The cloud provides a secure means of managing the primary source verification, healthcare credentialing, and access privileges in one consolidated interface. What better is that all the activities can be tracked and the software generates reports on a regular basis. These reports go a long way in helping the administrators glean valuable insights that help them optimize the activities for greater efficiency and productivity.
To sum it up, software for medical credentialing solutions is an absolute must-have for insurance payers to consolidate all the activities in credentialing workflow into a single user-friendly interface. Most of all, it empowers payers to get more things done with fewer resources.
