Delegated Credentialing: Best Practices

Credentialing is an essential part of effective healthcare provider operations. It’s necessary to receive reimbursement from insurance companies, become a part of the provider network, and ensure a provider’s smooth collaboration with a healthcare facility.

Verifying a healthcare provider’s credentials can be a complex and time-consuming process. Until it’s completed, the specialist can’t begin their work with your organization. Both healthcare facilities and service providers lose time and money.

While it’s possible to arrange credentialing in-house, many healthcare organizations choose to delegate this task to third-party service providers, such as a Credentials Verification Organization or CVO.

If you are planning to outsource credentialing, consider implementing these practices. They can help you achieve credentialing goals, ensure compliance, and speed up the process.

What is delegated credentialing?

So, what is delegated credentialing? Delegating credentialing is outsourcing the credentialing of your healthcare practitioners to a qualified third party. Credentialing is an administrative burden that many healthcare organizations don’t want to handle. By delegating this task to another company, they free up their staff while receiving high-quality services.

Delegating credentialing is one of the most popular third-party services that healthcare facilities use. It comes with a variety of benefits, including:

·        Lower costs – direct credentialing and re-credentialing is an expensive process. It requires your staff to reroute their resources to credentialing instead of focusing on revenue-generating tactics. Meanwhile, since direct credentialing often takes longer time than professional credentialing, you lose money because your practitioners can’t start providing services.

·        Shorter time – credentialing can take up to 12 months to be completed. With the right approach, it’s possible to cut this time in half. By outsourcing credentialing to a team of professionals, you can save time and money while getting high-quality services.

·        Smooth re-credentialing – practitioners and facilities require re-credentialing every three years. Since all practitioners need re-credentialing at different times, staying on top of the process can be complicated. CVO can take care of credentialing monitoring and arrange re-credentialing on schedule.

·        Patient satisfaction – by streamlining credentialing, you are giving your patients a chance to take full advantage of healthcare providers and reduce claims payment issues.

Overall, delegated credentialing is an excellent solution for organizations that don’t have the resources and experience for arranging direct credentialing. Regardless of the facility’s size and location, delegated credentialing is often the best choice.

Best Practices of Delegated Credentialing

Delegated credentialing can seem intimidating at first. However, implementing these practices can help you streamline the process and ensure excellent results of this collaboration.

1. Ensure Accuracy of Provider Records

The essence of credentialing is to confirm the practitioner’s ability to provide top-notch services to your patients. It often becomes critical to the success of healthcare organizations and minimizes medical malpractice claims while preventing high patient churn.

Since credentialing requirements can vary from one insurance company to another, as well as from one location to another, it’s integral to maintain accurate provider records and be ready to share them with the credentialing organization.

If you don’t maintain accurate provider files, you could face risks that turn into serious expenses. Meanwhile, failing to keep these records could result in penalties or even bans on enrollment.

You can help speed up credentialing if you encourage providers to collect and present all the necessary information ahead of the credentialing time. This allows the credentialing party to check the documents for each network application and tender them on time.

2. Choose the Right Service Provider

The key to ensuring a smooth credentialing process is finding an organization with sufficient experience in the niche. The CVO you choose to handle your practitioners’ credentialing process should:

·        Have experience dealing with relevant medical professions

·        Provide excellent communication options throughout the collaboration

·        Deal with both credentialing and re-credentialing without reminders or new contracts

Before settling on one credentialing organization, you can conduct several interviews and figure out which one of the candidates has experience in your niche. If you have several candidates with similar qualifications, you can compare quotes.

3. Make a List of Positions to Be Credentialed

When you delegate credentialing, you need to make sure that all positions in your organization that require credentialing are taken care of by the service provider. To do that, you would have to review your staff and make a list of these positions. Make sure to plan for other positions if you are thinking about adding them in the future.

The list of positions for credentialing should be a part of your agreement with the CVO. Otherwise, you could miss deadlines and face reimbursement issues.

Implementing Delegated Credentialing

Delegating credentialing requires close collaboration between medical facilities and third-party service providers. By streamlining communication with CVO or other credentialing services, you can minimize risks and avoid unexpected expenses.

If you implement the above practices in your delegated credentialing process, you can take full advantage of this effective outsourcing opportunity.