A physician reads our 5 Tips for Provider Credentialing on a tablet.

5 Tips for Provider Credentialing

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CredentialingOne Blog

5 Tips for Provider Credentialing

Posted on Monday, February 10, 2020

A physician reads our 5 Tips for Provider Credentialing on a tablet.

Follow these 5 tips for provider credentialing!

Here are 5 tips for provider credentialing to help you navigate the complex credentialing process that can often seem overwhelming.

5 Tips for Provider Credentialing:

Credentialing Tip #1: Don’t Delay!

This may be the most important credentialing tip: Get started ASAP. Begin collecting and organizing relevant documents and other material immediately. This includes CVs, references, updated contact information, education/work history, and more.

Even if a payor won’t start the credentialing process until 60-90 days out from a provider’s start date, it’s never too early for you to prepare. Because the credentialing process is lengthy and affects reimbursement, some healthcare organizations will not schedule a new provider’s start date until they’ve received all credentialing paperwork from the new hire. For example, you may not be able to start until 120 days AFTER you’ve submitted all (complete and accurate) requirements.

Many providers find that the credentialing process takes longer than expected. Do everything in your power to prevent delays that can result in postponed employment start dates and claim denials.

Credentialing Tip #2:  Be Proactive

Anticipate that there will be issues. Besides starting the credentialing process early, there are other actions you can take to minimize your chances of encountering delays.

For example:

  • If three references are required, obtain five. This way if one of your references can’t be reached, it won’t hold up the rest of your application.
  • If you can help it, don’t wait until the summer to start the credentialing process. Payors receive a lot of applications in the months following graduation, so you’ll probably see delays during this busy time.
  • Triple-check your paperwork and have another experienced professional look over your application to make sure you’re not missing anything. Mistakes and omissions are major causes for delay. If everything is correct on your first submission, it will save you a lot of hassle down the road.
  • Follow up. Stay on top of your application by checking its progress at least weekly. This will ensure you detect and resolve any deficiencies as soon as possible, since many states allow 60 days or more for payors to inform you of errors.

Credentialing Tip #3:  Understand Your State’s Regulations

Be aware of your state’s unique requirements or allowances. For instance, in some states you can bill for services performed during the credentialing process and in others you cannot.

Reciprocity agreements also exist between certain states and payors. If you’re already credentialed with a payor in one state, the payor may fast track your credentialing for another state!

Keep yourself updated on changes to industry laws at both the federal and state level so you can avoid any new or obscure rules falling through the cracks and causing difficulties. Likewise, you wouldn’t want to miss out on the benefits of laws that work in your favor, such as those related to reciprocity.

Credentialing Tip #4:  Use Credentialing Technology Solutions

We’re not talking about spreadsheets! You no longer need to manually track your compliance using this outdated method.

CredentialingOne offers a messaging alert system that updates you throughout the entire credentialing process. We also send automated reminders to providers 120, 90, 60, and 30 days prior to expirations of licenses, certifications, and other compliance requirements. You won’t miss critical deadlines because you’ll automatically be notified well before malpractice insurance must be renewed or continuing education credits are due.

Additionally, CredentialingOne technology can auto-populate forms, making the extensive amount of credentialing paperwork more manageable. We also recommend using our cloud-based technology for easier and quicker access to data, which speeds up the credentialing process.

Credentialing Tip #5:  Outsource Credentialing

When you outsource with CredentialingOne not only will you gain the benefits of our technology solutions, but your credentialing work will also be handled by a team of credentialing experts. You won’t have to worry about many of the credentialing tips above, such as keeping track of industry changes or following up on applications, because we will do those things for you – plus much more.

Whether you outsource credentialing or give it a go yourself, these 5 tips for provider credentialing will help make the process much smoother, faster, and an overall success!

By Stephanie Salmich

Preventing clinician burnout: Two clinicians cross their arms and appear stressed out.

Preventing Clinician Burnout by Outsourcing Credentialing

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CredentialingOne Blog

Preventing Clinician Burnout by Outsourcing Credentialing

Posted on Monday, January 20, 2020

Preventing clinician burnout is increasingly important to the success of healthcare organizations and the wellbeing of healthcare professionals.

Clinician burnout leads to higher turnover and costs, affects organizational productivity and morale, lowers the quality of care delivered, decreases patient satisfaction, and can result in medical errors and clinician depression and/or suicide.

Why Are Clinicians Experiencing Burnout?

Paperwork and administrative burdens, as well as working long hours, are top contributors to clinician burnout.

  • In a 2019 Medscape study, 59% of physicians said “too many bureaucratic tasks (e.g. charting, paperwork)” contributes most to their burnout.
  • “Spending too much time on paperwork” was one of the top three reasons nurses gave for wanting to leave their profession in RNnetwork’s national study.
  • Per the American Medical Association, a physician’s chances of experiencing burnout increase by 3% with every additional hour worked each week.

Doctors and nurses didn’t choose their profession for the joys of paperwork; most providers’ true passion is found in helping patients. Yet, physicians participating in a study published in the Annals of Internal Medicine spent almost 2 hours on administrative tasks for every 1 hour spent face-to-face with patients, and 1 to 2 hours of personal time at night on clerical work. And research published in the Annals of Family Medicine found that PCPs spend over half their workday in the EHR (during and after clinic hours).

Preventing Clinician Burnout by Outsourcing Credentialing

Before clinicians can even begin their careers, they immediately face the time-consuming administrative tasks required for credentialing and obtaining hospital privileges. Then once credentialed, on top of the excessive time devoted to clinical paperwork and documentation, they must balance ongoing credentialing maintenance in order to remain compliant and continue practicing medicine.

Preventing clinician burnout: Two clinicians cross their arms and appear stressed out.

Preventing clinician burnout begins with outsourcing credentialing.

Why not remove a few layers of administrative work by outsourcing credentialing?

CredentialingOne completes all hospital and health plan applications, tracks them to completion, and follows up on them for clinicians. We also provide re-credentialing and re-validation services, while monitoring clinicians’ compliance and sending them automated alerts concerning pending expiration dates.

Whether you are a new provider, starting a new practice, hiring new providers, opening a new location, or dealing with credentialing maintenance and compliance – we can help. Let us lighten your workload and give you back some valuable time.

Outsource credentialing and start preventing clinician burnout and reducing physician burnout for those already experiencing it.

By Stephanie Salmich


Outsource credentialing with CredentialingOne in 2020.

Why Outsource Credentialing in 2020?

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CredentialingOne Blog

Why Outsource Credentialing in 2020?

Posted on Monday, January 6, 2020

There are many reasons to outsource credentialing this year. Below are just a few of the benefits of choosing a credentialing services provider to manage the process for you.

Outsource Credentialing to Ensure Credentialing Compliance

Credentialing can become “out of sight, out of mind” following completion of the initial credentialing process.

However, the credentialing life cycle of a practice includes maintenance of provider credentials. Monitoring CE credits, expiring certifications, licenses, and insurance is a detailed task and without a dedicated credentialing team of experts, opportunities for human error are significant.

Re-credentialing or re-validation with commercial and government payors is also a part of the credentialing life cycle. Payors will re-credential or re-validate a provider every 2 to 3 years. Failure to complete re-credentialing or re-validation will result in claim denials and lost revenue.

Outsource Credentialing to Prevent Claim Denials

Credentialing directly affects the cash flow of a practice. Yet, many practices do not think about credentialing until something triggers there is a credentialing-related issue.

A BIG trigger occurs when a claim is denied or reimbursement is lower than anticipated. If the issue is not due to how the claim was filed, then the reason may be related to provider credentialing.

For example, a provider may not have completed re-credentialing or may not be participating in the plan in which the patient is enrolled. Non-credentialed or non-paneled providers do not receive any reimbursement for their services from plans with no out-of-network benefits (e.g. HMO plans).

Lower-than-expected claim reimbursement can also be attributed to the out-of-network benefits the patient’s plan offers. PPO plans, for instance, have out-of-network benefits with higher deductibles, co-pays, and lower co-insurance levels.

Every practice needs an experienced team solely committed to credentialing maintenance so that nothing slips through the cracks. Outsourcing with the CredentialingOne team yields the additional advantage of innovative technology that monitors credentialing compliance and automatically alerts you to pending expirations.

Outsource Credentialing to Save Time & Resources

A provider may see 25 to 35 patients (or more, depending on the practice) on an average day. Providing medical treatment is a full-time job; but making sure the practice is profitable is also both essential and time-consuming. This is the main reason practices outsource services to experts in various industries.

CredentialingOne’s expert staff and technology complete all credentialing documentation, track applications through fulfillment, and follow up when necessary. With CredentialingOne you can maximize cash flow by preventing claim denials and other credentialing issues and do so without sacrificing time and attention away from patient care.

Outsource credentialing with CredentialingOne in 2020.

CredentialingOne: Your external credentialing solution. Outsource credentialing with us in 2020.

Providers are in the business of healing – providing comfort and compassion to patients and their family and friends. Most chose this profession for their passion for helping others, not for the extensive administrative work and time that the credentialing process requires.

Connect with CredentialingOne in 2020 – outsource credentialing this year and let us take the burden off your hands!

By CredentialingOne

An annual health plan audit is performed.

Why an Annual Health Plan Audit is Critical to Your Success

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CredentialingOne Blog

Why an Annual Health Plan Audit is Critical to Your Success

Posted on Tuesday, December 3, 2019

Conducting an annual health plan audit is critical to the success of your practice. Over the life of a practice, providers and staff come and go and insurance companies add and terminate health plans. Keeping track of these changes is key to protecting your practice from legal issues and ensuring adequate cash flow.

Protecting Your Practice

When a new provider joins a practice, they must of course become credentialed and linked to the practice’s payor contracts in order to be considered “in-network.” However, most practices forget that they must notify their payors when a provider leaves their practice as well.

Payor contracts include language requiring a practice to send notification within a specific time frame when a provider terminates. Not only does notification of the termination date keep the practice compliant with these contracts, but it also protects the practice if the provider experiences malpractice issues or sanctions after leaving the practice.

Performing a health plan audit can ensure all payors are up to date on the providers currently associated with your practice.

Improving Front Desk Collections

A health plan audit is also crucial for front desk collections.

Turnover of front desk staff is not uncommon for any practice. It is vital that both your new and experienced staff members know the plans in which each provider participates. They also must be knowledgeable about the payors with whom your practice holds contracts.

Without a current roster of plan participation, the front desk will not know the appropriate co-pay or deductible to collect and your cash flow will bear the consequences.

An annual health plan audit is performed.

An annual health plan audit helps your practice maintain compliance and improves cash flow.

CredentialingOne’s maintenance and compliance services include an annual health plan audit. We can also provide health plan audit services on a standalone basis for clients.

The health plan audit process usually takes fewer than 30 days to complete.

Contact us today to learn more about how an annual health plan audit can protect both your practice’s liability and cash flow.

By CredentialingOne