Is Your Medical Credentialing Taking Too Long?

The Importance of Thorough Credentialing

The credentialing process for hospitals and health systems prioritizes in-depth research and meticulous accuracy, which means that it is not a speedy process, often taking from 90 to 120 days to complete. However, verifying a provider’s credentials is essential. Primary source verification must be done to confirm a provider’s education, professional license and certifications, medical training, work history, references, and more.

A healthcare facility’s accountability and overall reputation are dependent upon rigorous credentialing processes compliant with governing regulatory bodies, such as the National Committee for Quality Assurance. Inaccurate or missing information can cause delays which lengthen the process even further, directly impacting billing and reimbursement. Here are some strategic moves that healthcare organizations can take to ensure efficient credentialing processes for their providers.

Outsource Credentialing to Credentialing Experts

Healthcare credentialing should be an ongoing process, starting with new hires and continuing throughout the employee’s tenure with an organization. Provider information should be continuously monitored for any changes to exclusion or license status. It is critical for hospitals and health systems to know that everyone on the staff is compliant and in good standing at all times. If overlooked, your organization could face serious penalties, including fines, denied or delayed reimbursement, loss of participation in government healthcare programs, and loss of reputation.

Hiring and training an in-house credentialing team can add substantial overhead expenses and may not be an option for your organization. Hospitals, health systems, and pharmacies can save time and money by outsourcing their provider credentialing to credentialing experts.

Verisys is the largest Credentials Verification Organization (CVO) in the U.S. and has the most comprehensive database of excluded and sanctioned providers. Credentialing with Verisys shortens the process to as little as 30 to 45 days in most cases. Once credentialed, automated notifications, continuous monitoring, and with 99.9% identity matching your organization will know immediately if and when a provider’s license or exclusion status changes. By automating manual tasks, there will be less error, more efficiency, and shortened turnaround times for credentialing, which ultimately shortens the revenue cycle for your organization.

CVOs and Medical Credentialing Software

Another benefit of outsourcing your medical credentialing to a trusted CVO is the use of technology in the credentialing process. Medical credentialing software is no longer an option; it’s a necessity. There is simply too much room for error and too many limitations with manual searches. With thousands of federal and state sources to screen for debarments, sanctions, exclusions, and disciplinary actions, manual monitoring of your provider population is virtually impossible. Proven software and technology which continuously monitors these sources will ensure that your healthcare organization is in compliance at all times.

Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource. FACIS draws from over 5,000 federal and state primary sources including (but not limited to):

• Office of Inspector General (OIG)
• System for Award Management (SAM)
• Specially Designated Nationals (SDN)
• Food and Drug Administration (FDA)
• Drug Enforcement Agency (DEA)
• TRICARE
• Office of Foreign Assets Control (OFAC)
• Federal Bureau of Investigation (FBI)
• U.S. Department of Justice (DOJ)
• U.S. Treasury Department
• U.S. State Department
• All state-level Federal Healthcare Entitlement Program (FHEP) sources including state Medicaid exclusions, state Contractor Disqualification/Debarment lists, HEAT Task Force News, state Attorney General News, Federal District – Attorney General News, and Medicare/Medicaid opt-out lists

Manual searches not only create high risk for your hospital or health system, they also limit your ability to scale. Many healthcare organizations find themselves in a merger and suddenly serve more providers than their staff can handle. This could create a huge liability issue. With proven credentialing software, you never have to worry about scalability if you’re rapidly hiring and credentialing more healthcare providers.

Outsourcing credentials verification to a trusted CVO who utilizes software and technology to save you time and money allows your healthcare organization to confidently grow while keeping your focus on quality patient care.

Choosing an Experienced Partner 

Although credentialing software or engaging a CVO may be new to your organization, it’s not a new field. When it comes to credentialing, an experienced and trusted partner is critical. Verisys designed and built the first data-powered Software as a Service (SaaS) credentialing platform, CheckMedic, 20 years ago.

Because of our long credentialing history, we have the most comprehensive data platform in the industry with more than 320 million aggregated records that provide a longitudinal view of exclusions, debarments, sanctions, and disciplinary actions, allowing your organizations to see a provider’s complete history. Since 1992 Verisys has been collecting provider data from primary sources. This has allowed us to create a unique, longitudinal healthcare dataset that displays every possible record as well as long-term trends.

Our experience shows in our high standards. Verisys is the only CVO that is:

• National Committee for Quality Assurance (NCQA) certified for all eleven verification services
• Utilization Review Accreditation Commission (URAC) accredited
• ISO 9001:2015 (quality management)
• ISO 27001:2013 (information security)
• AICPA SOC 2 (customer data security certified)

Verisys stands behind our results 100% of the time. If your organization is ready to streamline and shorten your credentialing timeline, reach out today.

Written by Verisys Verisys transforms provider data, workforce data, and relationship management. Healthcare, life science, and background screening organizations rely on our comprehensive solutions to discover their true potential. Visit verisys.com to learn how we turn problems into power. Secure, configurable, and proven solutions Accurate, compliant, and complete information NCQA, URAC, and ISO accreditations/certifications Follow us on LinkedIn