How Delegated Credentialing Streamlines The Provider Enrollment Process

Delegated credentialing is a term that has become extremely popular within the healthcare industry in the last few years. With it, you can simplify and streamline one of the most arduous administrative tasks your clinic has to deal with.

So, if you wish to learn more about delegated credentialing and its impact on provider enrollment, read this article right now!

What is Delegated Credentialing?

One of the most common questions we get asked is, what is delegated credentialing? As the name implies, it’s a process where one healthcare provider allows an external provider to perform provider credentialing in their stead.

The reason why delegated credentialing is so popular is because it alleviates common administrative burdens from hospitals and clinics. It eliminates the need for a specialized onboarding and credentialing team, as well as expensive credentialing software.

Most importantly, veteran credentialing organizations are much faster doing this job than clinics and hospitals. They have well-established methodologies ensuring that providers are onboarded as quickly as possible.

4 Main Benefits of Delegated Credentialing

Nowadays, provider credentialing and onboarding is a process commonly streamlined by CVOs (Credential Verification Organizations). These entities specialize in providing credentialing services, alleviating the burden of traditional healthcare providers like clinics and hospitals.

For the most part, companies delegate this process to reduce administrative burden. The whole onboarding procedure is extremely complex and requires a dedicated team, which is why most clinics and hospitals prefer hiring an external provider. Besides using specialized software, CVOs have well-established procedures that would make credentialing and onboarding a breeze.

Without further ado, here are 4 main benefits of outsourcing credentialing to an external company:

1. Saves time and money

First and foremost, delegating credentialing reduces the required time for administrative processes. As these entities specialize in provider onboarding and rely on powerful automation tools, they can execute the process with ease. While you can also achieve great results by creating a dedicated in-house team, the empirical data has shown us that it’s much more efficient to go with an external service provider.

Time-saving is vital during the initial onboarding. Basically, you’re looking to expedite the transition from contract signing to credentialing. Keep in mind that you need to pay the provider as soon as you hire them, so slow credentialing can cost you several paychecks before the practitioner even steps into the office.

2. Streamlines the process

CVOs use advanced systems and create customized workflows tailored to your business. This can simplify the entire onboarding, making it faster and cheaper for your clinic. Most importantly, efficient streamlining removes the common obstacles and errors often present with credentialing.

Another major benefit of streamlining is that it alleviates the administrative burden from your hospital. Your management no longer has to worry about sending documents to payors, while payors can save a lot of time by passing over administrative duties to a provider.

3. Increases control

With delegated credentialing, healthcare providers have much more control over the data. Specifically, they can affect how the network is presented in the related payor’s directories. All changes to the provider’s status are introduced to the system in real-time, ensuring maximum compliance and reducing standard human error.

4. Increases everyone’s satisfaction

Faster onboarding is better for everyone involved, from the hospital to practitioners and patients. As mentioned, healthcare institution is looking forward to expediting the process as a way of cutting costs. On the other hand, practitioners won’t have to sit home idle and worry about how the process is going to end.

Most importantly, your patients will be much happier for faster credentialing and onboarding. They will have access to more and better practitioners as you can reduce the downtime between contract signing and the first day at work. This is especially important in big hospitals that have high employee turnover.

What Does Provider Hiring and Credentialing Look Like?

As mentioned, a veteran CVO can expedite every part of the credentialing process. They use sophisticated tools and are connected to the biggest databases to quickly verify physician’s data. Among others, CVO checks provider’s degrees, work experience, certificates, but also legal disputes they might be a part of.

Automated credentialing makes the process a breeze while also eliminating common errors such as obsolete or duplicate data. As a result, a clinic will learn everything there is about a provider and can quickly finish onboarding.

While the practitioner hiring and credentialing process can vary from clinic to clinic, here’s how it looks like in most cases:

• The process starts by filling out an application. Most clinics nowadays use online forms when hiring new doctors so that a practitioner can quickly and easily apply for a job. Depending on the healthcare institution, the application form can have from 10 to more than 100 pages.
• When applying for a job, a practitioner is responsible for submitting all relevant documents to potential future employers. Among others, they need to give insight into licenses and certificates, college degrees, work history, malpractice insurance carrier, DEA ID number, and other documents.
• After submitting all relevant documents and the filled application, the CVO team can verify the data. The provider will go through the doctor’s work history, education, malpractice carriers, peer references, and everything else that is relevant to the position. CVOs compare your documents against the main healthcare data sources.

• At this point, the hospital board will take into account all the information provided by the practitioner and corroborated by CVO to make their final decision. However, the process is far from over. In some cases, the decision-making might take up to a month or even more. Of course, this is all if we presume that a provider still hasn’t signed the contract with the hospital.
• Re-credentialing is another part of CVO’s job. Depending on a hospital or clinic, a provider might get short-term credentialing lasting just a few months. In these cases, a provider should undergo the process of re-credentialing, where his or her data will be checked once again for potential changes.

While the process might seem long and arduous, with the right technology and CVO, it can be much simpler.