Healthcare Credentialing Solutions

Medical credentialing is verifying a medical practitioner’s qualifications to ascertain his or her ability to provide healthcare services. As part of the healthcare credentialing process, insurance payers verify a physician’s license, education, certifications, and experience and find out if there is any malpractice history. Credentialing solutions consist of features that streamline the process of obtaining the documentation from providers and verifying their authenticity, not to mention reducing the costs involved. Payers might refuse reimbursement to providers not credentialed and enrolled with them.  

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Explore Medical Credentialing

Credentialing and re-credentialing of in-network providers are among the major segments of revenue cycle management of practice managers. The healthcare providers, hospitals, FQHCs across the USA are struggling with manual, time-consuming, and traditional medical credentialing methods. These processes are fragmented, error-prone, and far away from smart integrations such as CAQH Proview, Peer review, NPI Registry, CME credit scoring, and more. OSP can solve this challenge by offering custom healthcare solutions to automate your medical credentialing workflow in a centralized manner. In centralized credentialing, two or more than two healthcare facilities share the cost of credentialing providers saving the total cost required. Even the providers get credentialed once, making the process more hassle-free and increasing the goodwill between providers and administrators. We program the medical credentialing system as per your needs to eliminate credentialing a single provider in multiple systems while maintaining the efficiency and data integrity of credentialing to complete your provider credentialing checklist.

Provider data verification is a time-consuming task and errors cause more harm than help. It includes collecting required data from the physicians, developing the credentialing strategy, auditing the provided data for accuracy, validating the data and certificates, managing provider profiles, and following up with payers. OSP’s long-standing experience in healthcare automation allows streamlining the credentialing workflow process by automating multiple inbound processes such as provider data verification, task management, provider data monitoring, document expiration alerts, and attestation aging credentialing metrics, OIG monitoring, and more. We help you in better hospital management system with medical credentialing tasks with real-time, intuitive dashboards to enhance productivity and eliminate the redundancy in the process. 

Managing providers data requires a robust data management system. Provider database management with optimum data security is challenging and expensive for many providers and clinics. OSP can help you successfully access all the provider data with CAQH Proview integration. The Council for Affordable Quality Healthcare (CAQH) is a non-profit association of health insurers in the USA that collects and maintains a database of provider credentialing data. Almost 1,000 health plans, hospital management, and providers groups use CAQH ProView to streamline healthcare credentialing, improve in-network provider directories, and speed claims processing and adjudication. OSP can tailor healthcare solutions for insurance credentialing to maintain a single source of provider data across all your systems. Whether you require to send provider information into your EHR/EMR or push data to or pull from CAQH, our healthcare integrations will solve your challenge using standard HL7 messaging protocols.

Whether you are looking for Medicaid provider enrollment or Medicare provider enrollment, we can simplify the credentialing document tracking in real-time . Healthcare provider solutions should be user friendly, interactive, and manageable. It’s easy to capture prospect forms and signatures and immediately send materials through your enrollment workflow. Modern systems are capable of capturing and tracking all the required medical credentialing data and signatures at the point of contact, avoiding delays, costs, and missed enrollments. We have good experience in building HIPAA compliance solutions from scratch, where we maintain the data security as per the United States standards with high regard. 

Interoperability in healthcare is the key when we need to share essential provider data files through electronic data interchange (EDI). We can solve the challenge of interoperability while handling the insurance credentialing certification and licenses. OSP can program medical credentialing solutions capable of tracking, monitoring, and managing the credentialing data seamlessly. We can build healthcare cloud-based data storage to manage important files regarding the provider’s attestation and provider credentialing processes in the USA. Users need to manage primary source verification, healthcare credentialing, and privileging needs in one comprehensive solution where they can update, download, edit and keep track of versions on the same platform. As per your needs, we can build an interactive dashboard to manage provider demographics, their experience, CME tracking, educational qualifications, NPI number, i-9 documentation, EIN, and more.

Healthcare credentialing solutions maintain a wide variety of inbound processes like document capturing, tracking credentials, maintaining the provider’s data, managing the data securely, credentialing, and provider privileging. A single platform with a centralized management system can solve the challenge of automation and task management. OSP can understand your challenges and build a smart system specifically for your business for seamless task management. We ensure the system meets medical credentialing requirements from the Joint Commission and the National Committee on Quality Assurance (NCQA). We help you eliminate administrative paperwork, expensive, time-consuming, and complex processes, and replace it with a simplified healthcare credentialing solution.


A provider who has undergone the medical credentialing process will be included in the payer's network. All the members of the payer's health plans would be able to visit the provider for consultations and other healthcare services. Being credentialed by a payer drastically increases the number of potential patients who would be turning up. This will increase the revenues of the providers.

OSP can design and develop credentialing systems to include features that streamline the entire credentialing process. The entire lifecycle of the credentialing process for healthcare providers is highly elaborate and is followed by many steps to include the physicians in the payer network. In light of this, our credentialing software will accelerate this process and reduce the overhead and time required to complete it.

The entire process flow of health care credentialing is tedious and involves numerous manual and repetitive steps. But solutions such as the credentialing management system that OSP would build introduce automation into credentialing activities. As a result, the staff at insurance organizations who handle credentialing processes can work much faster without worrying about errors. Automation eliminates or minimizes the need for human intervention to boost the speed and productivity of operations.

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Medical Credentialing Software Services


Streamline Credentialing Workflows With Healthcare Credentialing Software

  • Replace Manual, Paper-Based Processes With Digital Ones
  • Credentialing Management Software Offers A Central Repository For Provider Data
  • Track Deadlines For Certificates Using Credentialing Solutions
  • Validate Providers’ Credentials and Qualifications Rapidly
  • Receive Notifications For Renewing Licences

Automate Workflows In The Medical Credentialing Process

  • Leverage the Benefits of the Latest in Healthcare Automation Technology
  • Increase The Speed Of All Workflows In Healthcare Credentialing
  • Facilitate Compliance Among Healthcare Organizations and Providers Faster
  • Verify Providers’ Continuing Medical Education Requirements
  • Generate Detailed Reports Around Medical Credentialing Activities

Cloud-Based Credentialing Management Software

  • Access the Health Care Credentialing Software While on the Move
  • Secure Off-Site Storage Eliminates the Need For On-Premises Storage
  • Scale up or Scale Down the Storage Requirements of the Credentialing Software as Needed
  • Ensure Data Security Through Access Controls and Audit Trails
  • Facilitate Centralized Medical Credentialing For Faster Processes

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Frequently Asked Questions

Medical credentialing is the process in which a physician’s qualifications are verified to ensure they are fit to provide medical services. Credentialing entails analyzing the physician’s academic qualifications, practice history, education, training, and history. Additionally, payers also carry out physician credentialing to enrol them in health plans so that their services can be covered.  

Medical credentialing is the process of organizing and verifying the background and qualifications of a physician. This includes assessing their education, certification, work history, references, lawsuits (if any), credentials, etc. It is important to ensure patient safety and enrol doctors into payers’ health plans.    

To sum it up, the credentialing process mainly involves three steps –  

  • Obtain physician information and credentials  
  • Verify the information  
  • Award the credential  

An organization providing medical credentialing services manages the applications and other processes required for physicians and other stakeholders. Such companies streamline the entire medical credentialing process as they are well acquainted with it and are often helpful in resolving any issues that may arise.  

Providers need to be credentialed when they begin their practice, move to a new state, change employers, or want to accept new insurance from patients. The initial credentialing application could take weeks since everything from work history, education, background, qualification, and experience would need to be included.    

Medical credentialing is the process in which a physician’s qualifications are verified to ensure that they are fit to provide medical services. It involves the assessment of the physician’s professional and educational background. The credentialing process would also check certifications, work history, practice history, lawsuits (if any), and all the necessary documentation.  

Credentialing establishes the physician’s proficiency and ensures that they are qualified enough to provide medical services. It is important to ensure public safety and for insurance companies to enrol physicians into their network to cover their services.  

The process of medical credentialing works by verifying a physician’s credentials with primary sources. In other words, a credentials verification organization (CVO) will contact the university from where the provider graduated and completed their residency and verify the provider’s degree and other academic credentials. Furthermore, the verification organization will also contact the licensing agencies and certification boards for further assessment. This is followed by checking work history from previous hospitals.   

The costs of credentialing depend on the provider’s specialty, the type of facility, and the CVO doing the credentialing. The application fee for this process can be about $300 – $400 after the initial credentialing; periodic re-credentialing would need to be done, which will cost lesser. The cost would also depend on the number of insurance companies the providers credential with.  

Healthcare credentialing software is a digital platform that insurance companies and healthcare organizations use to store and manage physician records. It streamlines the entire credentialing process and reduces its time and costs. It ensures that physicians and other providers have licenses and certificates.   

  • Collect all the documents necessary for filing credentialing applications from the provider  
  • Store them all on a secure credentialing software database  
  • Apply the formats specific to the insurance company after verifications  
  • Track the status of the application from the payer  
  • Obtain the enrollment number from the payers and pass it on to the provider  
  • Update the database periodically  

Credentialing management software is used by healthcare organizations and mainly by insurance payers to ensure that the providers are qualified to provide medical services. Payers use medical credentialing systems to include providers in their networks and cover the services they offer to health plan members.  

The process of credentialing would initially include verification of the following –   

  • Education   
  • Degrees  
  • Licenses  
  • Work history  
  • Board certification  
  • Malpractice history (If any)  
  • Lawsuits (If any)  

In addition to these, there may be verifications of other documentation and background depending upon the specialty and healthcare organization of the provider.  

Credentialing establishes a physician’s qualifications and expertise to provide medical services to patients. It is a way for stakeholders in the healthcare industry to assess providers’ proficiency and ensure patients’ safety. For insurance payers, credentialing is a way to include providers in their network and cover the services of providers.  

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