Credentialing Software, Payor Enrollment, CredentialingI’m genuinely surprised when meeting with a new client and learning their credentialing and provider enrollment staffs aren’t utilizing the same software platform. Understanding the two jobs are disparately different and employees are often in different departments or divisions, there’s still one imperative reason why they should, at a minimum, be integrated – Provider Information.

Provider Evaluation

When a healthcare organization is vetting a new provider, the process usually begins in the medical staff office (MSO) where the provider is required to complete an application, hopefully electronic, and submit their information. The Medical Staff Professional (MSP) generally begins by running a few 'lead' searches to ensure the provider meets “minimum requirements” before beginning the entire credentialing process.

Once the provider passes the initial 'lead' check, and sometime during the credentials investigation and verification, the MSP notifies the Provider Enrollment Specialist (PES) of the new incoming provider. This initial encounter between the MSP and PES is oftentimes manual - either by phone or email – delivering the provider’s contact information. The PES then begins to initiate their processes, which often entails contacting the provider and collecting much of the same information provided to the MSP.

Discrepant Information

Besides the obvious duplication of work and burden on provider and staff, duplicate or disparate systems can create discrepancies in the data/documents received and stored. If the provider doesn’t understand both processes, they’ll now be filling out similar but not the same documentation, providing duplicate information and duplicate copies or records. The result is often that one of offices may not receive the necessary information needed to complete their respective processes!

Industry Best Practice

Today’s industry “best practice” should include utilizing a credentialing software system capable of gathering provider information once and sharing that data across multiple departments. Advanced credentialing software enables the creation and completion of required forms, letters and payor applications with provider information already stored within the system. This feature streamlines and simplifies some of the more cumbersome tasks in credentialing and payor enrollment that require absolute accuracy.

Streamlining communication and utilizing effective credentialing software in the Medical Staff Office and Payor Enrollment Department is an effective way to create efficiencies and reduce errors in the onboarding process. Implemented correctly, your organization can reduce potential risk and onboarding time while increasing reimbursements and provider satisfaction.


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