In healthcare, Medical credentialing is the process by which insurance companies verify and assess if a healthcare provider is qualified to provide the relevant medical services. These would include doctors, dentists, physical therapists, as well as mental health experts. It is an important process by which providers are included in an insurance payer’s network. In other words, payers carry out credentialing to ensure that members of their health plans can avail of medical services from a certain provider.
Needless to say, it is a fragmented process with an elaborate bureaucracy and tedious workflows. The activities surrounding credentialing take a significant portion of a payer organization’s resources. That is why it is essential for payers to implement robust credentialing management software. Healthcare credentialing solutions streamline all the activities around credentialing and optimize the operations at insurance companies. But there are numerous companies that sell such software. So, it becomes necessary to know which kind of credentialing system is suitable for your organization. Let’s look at some of the desirable features of healthcare credentialing software solutions –
This is perhaps one of the most important features that you need to look out for. The entire value structure that is to be derived from implementing a software solution is its ability to streamline workflows. What better way to do that, other than automation??
Automation has maximized the productivity and efficiency of just about every activity in every industry where it has been implemented. When it comes to medical credentialing, obtaining the information about providers, auditing that data, validating the certificates, managing profiles, task management, document expiration alerts, and so forth.
By automating these activities in part or completely, payers stand to gain significantly in terms of efficiency, minimized errors, and most of all – reduced overhead.
Document Management and Tracking
The medical credentialing data includes everything obtained from the providers as part of the process. Highlighting prospect forms and signatures, and sending materials to the workflow, coupled with managing essential files regarding providers’ attestation are some of the activities that are carried out using the solution. So, it is important for the platform to feature a secure cloud for storing the data relevant to the activities mentioned before. Such a feature would bring about one comprehensive software solution where users can update, download, edit, and keep track of versions.
This is an essential feature for simplifying the workflows related to medical credentialing.
Like every workflow in every organization belonging to virtually every industry, there needs to be a comprehensive reporting about the activities. So it shouldn’t come as a surprise that credentialing management software needs to have an effective reporting functionality to let the management have a bird’s eye view of the operations.
As mentioned above, credentialing makes up a significant part of the insurance company’s operations, and also takes up quite a few resources. So, knowing how they are spent becomes extremely important. This feature within healthcare credentialing solutions identifies which process or team is experiencing inefficiency and enables the management to take appropriate measures to boost productivity.