Insurance credentialing (the act of necessity to get on a list of insurance panels) is a disputable process for most of health providers. This issue made several medical credentialing software companies to promise that their software will simplify the process. But the question is: “Really?”
This article is an overview of how insurance credentialing software works, and (if your company has more then 100 health providers) how it will not save your time, or make the whole process easier.
Revelation: As an owner of a medical practice with several mental health professionals, I started to work with medical credentialing software a few years ago and I have spoken with some major companies. Apart from having a small medical practice, I often discuss with various medical practices, usually counseling practices (through http://thriveworks.com). Probably the most important for the reader interested in author bias, I also have a company offering medical credentialing services for health professionals (athttp://medicalcredentialing.org). Due to my experience with credentialing around 100 health professionals, I can affirm that medical credentialing software is unable to enhance the efficiency of my services for my employees, or my clients.
1) The Software Demands Hours of Training
The general principle how the credentialing software functions is as follows: Provider enrollment applications are in paper form, thus it is necessary to scan them into the software system. The paper-based applications are “mapped” i.e. they have to be turned into an electronic form, while the information can be easily typed.
It seems to be simple, however, its realization is difficult. Training itself is a toilsome process that has to be overcome in order to learn how to use the software. The largest medical credentialing company asks new clients to send their employees for a training which takes a whole weekend.
For most health practices it would be more effective to manually fill out the provider applications. It causes the uselessness of the credential software. But, additionally…
2) The Use Of The Software Is A Waste Of Time
In spite the fact that somebody has passed the training to use medical credentialing software, the software will not save time for practices which have less than hundred providers. For medical practices with more than hundred providers which need to be included into certain group (for example a group of ten) of insurance panels, the software can save some time. Only one application is fulfilled for each provider and the information is imported electronically onto the other 9 applications. Hence, it is not necessary to complete every single application.
As it was already mentioned, the problem for the practice with less than 100 providers is basically the scanning every single application into the software, which can take many hours. Moreover, it does not guarantee 100% correctness of performance and a possible configuration will be unavoidable. Therefore the saved time is wasted by fixing the software.
3) Medical Credentialing Software Programs are not equipped with all required applications
There are hundreds or thousands of provider applications of various insurance companies from the USA in the systems of Medical Credentialing Software companies. It is true, however the biggest medical credentialing companies – when you actually get to the core of the issue- agree that they have less than half of the forms which a customer requires (for example if you work with behavioral health such as forgettaboutit. The amount of behavioral health applications in the system is not sufficient).
You should be aware of the fact that even if the software has the application which you need, it does not have to be necessarily truth. Health insurance companies frequently update their provider application forms (often every 6 months) and medical credentialing software has no feature for tracking or keeping up with this. Consequently, after submitting an application from medical credentialing software, it cannot be approved because it is not considered to be the most up-to-date item.
4) Medical Credential Software is Helpless for Online Applications
A lot of insurance companies changed their paper-based applications for solely online documentation. It makes medical credentialing software helpless because there are not any paper documents for scanning. To conclude…
5) Filling out the provider application is just a beginning!
Medical credentialing software companies assert that they help health organizations to put health providers´ information down on the paper-based documents in a shorter period of time.
Taking into consideration the proves stated above, I do not think that most of the practices under 100 providers as well as larger companies would agree that the reason why medical credentialing is a time-consumer have almost nothing in common with completing the application. Instead…
The Basis of Medical Credentialing
Getting on insurance panels can be exhausting because (1) it is a challenge to convince insurance company to admit your application because some panels considered to be good state that they are “closed”, (2)provider applications often change, and all the applications are different, (3)credentialing demands excessive amount of documents that have to be provided accurately, (4) the applications are frequently lost by insurance companies, or get stuck in the review proves, (5) in order to get on insurance panels it is necessary to repeatedly call to insurance companies so you can inform about the state of your application, and to move it closer to its completion.