Healthcare Credentialing is an uphill task. With the growth of technologies like EHR and mHealth, healthcare IT experts have developed various applications to manage and simplify complex healthcare tasks. However, earlier, it was mainly a manual process, but these processes are automated now with technology. Healthcare automation technology and HIPAA security, IT develops created Healthcare Credentialing Software.
Manually assessing providers’ educational backgrounds and practices is a taxing process. But, healthcare credentialing software is the right solution to this complex process. It saves time, money, and resources for provider credentialing. Unlike paper-based credentialing, where documentation errors were common, the provider credentialing software speeds up the process without any errors.
Healthcare vendor credentialing companies help healthcare organizations and insurers manage their records, check their essential certifications and licenses. Further, providers and physicians aiming to build a secure and reliable care service should integrate provider credentialing software to assure patients’ care quality.
Challenges Impacting Healthcare Credentialing Software Development
Healthcare providers still experience some critical challenges in healthcare credentialing software development. Strategic planning of the healthcare credentialing software can eliminate these challenges-
Lack of updated health information– The whole process of credentialing is based on providers’ information. Incorrect or incomplete information on the provider’s application is a major concern in developing provider credentialing software. A slight change like phone number or address requires re-attestation in the CAQH database to process the application. So, providers must keep updating their information on the database regularly, as it ensures up-to-date healthcare credentialing software.
Threat to Privacy and security issues– If any software or application experiences frequent security threats, then it’s time to change it. Privacy issues impact credentialing software and the process too. Providers and developers need to check the background information and provide accurate details to avoid security and malpractice.
Failure in Updating Information– As credentialing is a complex process, physicians providers often fail to succeed in using the software. The problem is not updating their credentials regularly. Considering the area or state of practice, the providers/physicians must keep updating their license as per state regulations. So, if providers’ details aren’t up-to-date, then it can hinder the healthcare credentialing software.
Missing Deadlines– Providers and physicians often experience problems in the timely submission of credentialing documents. It’s due to insurers or other stakeholders, who take months to process the providers’ applications. Automating the process of credentialing makes it easier and faster too.
Common Healthcare Credentialing Mistakes
Data Entry Errors– One of the most common mistakes in credentialing process in healthcare is data entry errors. Due to the high frequency of data entry and verification, even minor neglect cause problems in reimbursement, denial, and delays in claims. It could even lead to major issues like the Government holding the providers responsible for the failure in credentialing, not the healthcare credentialing companies. However, healthcare vendor credentialing companies and providers need to be attentive while filling in the information.
Lack of data authentication– Another mistake that leads to error is failure to provide authentic information or missing out on critical information. Data provided in the credentialing system is verified by contacting the primary witness. If there is a mismatch or some missing details, the verifier doesn’t prefer to go for the secondary source of verification. Hence, data authentication needs crucial attention in the credentialing process for healthcare providers.
Incomplete investigations– If healthcare companies fail to resolve internal conflict among entities, it can lead to credentialing failure and patient safety. Healthcare organizations need to provide accurate information about such conflicts to the credentialing software too.
Features to Consider in Healthcare Credentialing Software Development
Now that you know about the challenges and common mistakes, you must know the must-have features of healthcare credentialing software.
Cloud-Based Software ( HIPAA Compliant)- Developing a cloud-based medical credentialing software must ensure its portability of data. Opting for a cloud-based provider credentialing software with HIPAA compliance is a smart choice. It will allow employees of the healthcare company to access the software from anywhere, any device.
Integrated with CAQH– Ensuring the privacy and safety of credentialing data is essential. So, integrating your software with CAQH based providers’ information is beneficial for your integrated care management and electronic data exchange.
Centralized Credentialing- A centralized credentialing software is an added advantage for healthcare providers. It reduces the burden of the credentialing process, minimizes costs, and offers an easier transition with insurers. Besides, it improves healthcare providers’ solutions. So, opting for one is a wise decision.
Secured Data Management– In a healthcare data management software system, data is the most significant element. And in healthcare credentialing, data poses the same threat. But with providers’ credentialing software, the data is secure and easily transferred. This helps organizations improve their interoperability, medical records management, and more.
Automated Workflow- Healthcare credentialing isn’t a one-step process. Data collection, strategizing, data entry, data verification, and regular communication in healthcare credentialing are the multiple steps. However, provider credentialing applications automate these processes, simplifying the workflow. You can use healthcare analytics solutions or clinical informatics to sort and collect credentialing data to ensure the right information is entered to enhance the workflow.
How Credentialing Software Development Helps Providers
With custom healthcare solutions quite on demand, healthcare providers are now actively opting for health care credentialing software. It benefits the healthcare providers in different ways, which are-
Fully compliant with Regulations– Regulatory compliance is a big thing. Healthcare credentialing software takes off the burden of manual auditing. Moreover, it helps healthcare organizations retrieve necessary information whenever required through automated auditing and complete organization. Besides, authentically compliant credentialing software ensures patients’ safety in the long run. That means, in a way, it improves population health also.
Easier to Train Staff About Credentialing– Unlike manual credentialing, the chances of committing mistakes are high. However, with healthcare software, the employees are less stressed about errors. Also, it’s much easier to train the staff about credentialing through software.
Faster Processing and Saves time- Managing the tedious administrative data entry and verification tasks through credentialing software save providers valuable time. Plus, the automation in the software also reduces processing time. So, no long waiting time or work pressure on employees.
Reduces Errors in credentialing and provider application– Manual job is bound to encounter errors. However, automating the same process eliminates the chances of committing mistakes. Moreover, data analytics helps credentialing software to collect and add relevant data of providers.
Customizable Features and Fewer Paper-based- Healthcare credentialing software offers providers with personalized features. So, if the providers want credentialing process in medical billing or physician credentialing, the software can include more features. Besides, it saves paper through automation. This integrated health system ensures that providers get the license without any hassle and serve patients with full dedication.
No Burden on IT– If your organizations’ outsourced healthcare credentialing software, there is no burden on the in-house IT department. Moreover, healthcare providers without IT support can directly outsource provider credentialing software services to save money and resources.
Outsourced Credentialing Software or Hospital Software- Which is Better?
Credentialing software leveraged by providers is primarily of two types- outsourced software and hospital deployed. To understand which is better, here are some contrasting elements you should know before investing in anyone.
Healthcare Credentialing Software development ensures proper regulatory compliance, up-to-date software, and hassle-free licensing that benefits healthcare providers in many ways. Moreover, in the developmental, you should keep track of the challenges and mistakes impacting the implementation. Besides, you must also include all standardized features to offer providers easy licensing and improve patient care service.
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Written by Riken Shah linkedin
Riken's work motto is to help healthcare providers use technological advancements to make healthcare easily accessible to all stakeholders, from providers to patients. Under his leadership and guidance, OSP Labs has successfully developed over 600 customized software solutions for 200+ healthcare clients across continents.