How to Speed Up Your Medical Credentialing Process

You already know how important the credentialing process is to your organization. Done effectively, it saves time and protects your organization from a scenario where insurance claims will be denied. With tighter regulations and many more administrative duties added to your facility’s already busy schedule, credentialing can seem like a bear of a job to get done. The process has to be handled precisely. Missing or inaccurate information can lead to a denial which can impact everything from scheduling to your revenue cycle management.

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In order to speed up your credentialing process, it has to be handled with precision. Developing a solid protocol for your process will help streamline credentialing and avoid common errors that cause denials.

Tips to Speed Up Your Credentialing Process

  • The Right Software. If you’re handling your credentialing process in your own facility, it’s imperative that you use the right software. When choosing a software, make sure the vendor can answer questions and offer support for your staff. Your software should be user friendly and aid in making certain that all information is included. One of the key problems in denials is missing information. With the right software, the user can be alerted before submissions.
  • Streamline your Processes. You may have the start date for a new physician well in advance. That doesn’t mean you should wait until the last minute to start the credentialing process. Remember that each insurance company has a different process and their own schedule. Waiting until the last moment can mean that you won’t have approval in time for the start date.
  • Stay Proactive in Gathering Information. Part of the process is in gathering the pertinent information from the physician. The problem is that physicians don’t often need to work with credentialing, so they’re not sure what information they need to get for your and may leave things out. Your staff should stay proactive with gathering all the documentation, giving your physician a hard deadline so that the credentialing schedule can stay on track.
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  • Protocol Before Submission. Most of denials are caused by easy to spot problems. It might be an inverted number on your physician’s information. It might be missing information on their work history or malpractice insurance. Make certain that your protocol for credentialing includes a second check of all of the information contained in the application. This might be through the software you’re using and it also might be a second person to verify the application is complete before submission. The software can be impeccable, but it’s still a good idea to have a person verify that the information keyed in is accurate.
  • Stay Current on State and Federal Regulations. It’s important that your credentialing staff stays current on all regulations.
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Your credentialing process can be streamlined significantly with the use of current technology. Using analytics, you should be able to determine the percentage of declined applications and pinpoint the reasons they were declined. This offers your organization concrete ways to eliminate current issues in the process through retraining of staff or replacement of outdated software.

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