Three Tips to Enhance Your Healthcare Credentialing Processes

Healthcare credentialing is a critical process that ensures medical professionals meet the necessary qualifications and standards to provide safe and effective patient care. 

But it can be a bottleneck, slowing onboarding and preventing hospitals and practices from providing better, speedier service to their patients. 

Healthcare credentialing is a complex procedure that involves verifying an individual’s education, licenses, certifications, and professional experience. Due to its multifaceted nature, credentialing is prone to errors and inconsistencies. This is hope, however. Exception management and human oversight can play essential roles in maintaining the accuracy and integrity of the credentialing process.

The complexity of healthcare credentialing

To confirm that healthcare providers have appropriate qualifications and are in good standing with regulatory bodies, the process of credentialing requires verifying numerous documents from a myriad of sources. The process involves verifying educational backgrounds, professional licenses, board certifications, and clinical experience and it can take anywhere from several weeks to several months.. 

Adding to the headaches is the fact that every provider credentialing process is different, often combining scans of analog and digital credentials. Each of these steps, and the interplay between them, increases the likelihood of errors. And, of course, the more  errors there are, the longer it will take a hospital or practice to onboard clinicians to serve patients.  Errors also can expose hospitals and practices to increased litigation. 

To resolve these issues, hospitals and practices need an effective exception management protocol. 

Exception management: ensuring accuracy and efficiency

Exception management refers to the systematic identification and resolution of the discrepancies or anomalies within credentialing data. Common exceptions include outdated licenses, incomplete documentation, or conflicting information from different sources. 

Effective exception management systems flag these issues promptly, allowing credentialing specialists to address them before they impact patient care.

Technology can help.

Artificial intelligence-based automated systems are growing in popularity, and for good reason. They swiftly identify irregularities in large volumes of data, highlighting simple discrepancies faster than a human could. For instance, a software program might flag that a physician’s license is set to expire soon or identify discrepancies between reported and actual clinical hours. Utilizing robotic process automation in the credentialing system is another fantastic way to reduce administrative burden and increase efficiency. 

While these tools are valuable, artificial intelligence analyses are in their infancy and still do not catch all exceptions – and that point  brings us to the need for a strong human element in credentialing. 

The importance of human oversight

By their nature, computer automated systems are limited by their programming and can only address predefined issues.As a result, human oversight is critical in cases where exceptions require subjective interpretation. 

For example, determining the relevance of a physician's continuing education credits or assessing the implications of a disciplinary action may require a nuanced understanding that only a trained professional can provide. Additionally, credentialing specialists play a vital role in maintaining relationships with healthcare providers, offering personalized assistance and guidance throughout the credentialing process to ensure care providers can start practicing in the shortest time possible. 

Radiant Healthcare brings technology and the human element together.

To promote accuracy and efficiency, our firm employs a Quality Assurance Team to review any error flags and to ensure  algorithms have properly parsed scans of documents. Blending the speed of machines with human oversight creates a more accurate and efficient credentialing workflow. 

Best practices for effective credentialing management

Exception management and human oversight are critical components of the healthcare credentialing process. While technology plays a significant role in identifying and managing exceptions, the expertise and judgment of human specialists are indispensable for ensuring accuracy and compliance. 

Here are three rules your practice or hospital can use to improve credentialing:

• Leverage technology: Utilize advanced credentialing software to automate routine tasks and identify exceptions promptly.

• Train credentialing specialists: Invest in training and retaining a credentialing team that works in conjunction with automated tools. 

• Establish robust exception management processes: Ensure a clearly defined exception management process is in place.

By integrating advanced technologies with human oversight, healthcare organizations can enhance the efficiency and reliability of their credentialing processes, ultimately contributing to higher standards of patient care and safety.