Your Prescription for Choosing the Right Credentialing Solution

Ready to tune up and speed up your payer credentialing process? Here are 10 questions to ask before you choose a solution

As healthcare organizations merge, acquire, and consolidate in greater numbers, and the industry as a whole shifts from volume-based to value-based care, there’s been a marked demand for efficiency tools like credentialing solutions. And, more demand, has led to more options.

VerityStream is packed with industry experts. Our team includes former NAMSS presidents, and leaders of CVOs and Medical Staff Offices – with deep experience helping organizations create streamlined and efficient credentialing processes. We know one thing for sure: Not all credentialing solutions are created equal.

While many vendors might look alike, it’s our experience that they are not. If you're in the market for a credentialing solution, we encourage you to dig deep and ask the right questions to identify the best fit. To help you do that, we’re sharing a list of the 10 questions recommend you ask during the credentialing solution selection process.

#1 How will your solution enable us to speed up our credentialing processes?

Only about half of the provider enrollment professionals we surveyed use some type of software solution to help automate their processes. The rest continue to manage provider enrollment by keeping data in paper files, Excel spreadsheets, Access, and homegrown databases. When it comes time to automate, you shouldn’t have to create your processes from scratch. A comprehensive credentialing solution delivers best practice workflows and a deep library of instantly deployable content to help you rapidly launch and manage best practices for provider enrollment, expirables management, data validation, integrations with other systems, online provider tools, and more. With best practices in place, you’ll get paid faster.

#2 Does your solution offer intuitive provider enrollment?

Today’s healthcare providers are being subjected to increasing requests for data. The requests come in different formats, on different schedules. A solid credentialing solution offers you a method to easily auto populate required forms and online sites (PECOS, Medicaid, etc.) and the ability to allow providers to ‘claim their profile’ using real-time validated data from sources like AMA, CAQH, and other regulatory bodies.

#3 Will your solution help me improve communication and integration with our network of business partners?

As the industry continues to shine a light on patient outcomes, hospitals, medical groups, healthcare providers, patients, payers and everyone in between, will need to collaborate and share data in new ways. Look for a solution that features up-to-date, standardized industry data tables that places all the data you need within easy reach including data from: payers, hospitals, malpractice authorities, universities, state and local regulators, the DEA, and more.

#4 Will your solution allow us to truly collaborate and go paperless?

When it comes to credentialing, paper is so yesterday. Your credentialing solution should serve as a one-stop shop for your team and your providers to share data and as such, should allow you to easily upload, store and share as many files as you need to.

#5 How does your solution integrate with CAQH?

You likely can’t avoid integrating with CAQH even if you have your own credentialing software. A top-notch credentialing solution is able to send push and pull data requests between your system and CAQH’s ProView database. This will eliminate double data entry, reduce errors, and facilitate information sharing/compliance.

#6 What type of reporting does your solution provide?

Over time, your credentialing solution will collect massive amounts of data and you need to be sure that the system will help you make sense of that data (even if you are not an Excel expert) by turning it into graphical, easy-to-interpret, actionable information. Ask for samples of the reports you currently run or desire to run.

#7 Is the solution available via an on-demand/cloud delivery model?

Cloud computing is revolutionizing the healthcare industry and credentialing software solutions are increasingly moving to the cloud. With a cloud-based solution (often called SaaS) your credentialing software partner hosts the software application and hardware infrastructure for you. This means there is no hardware to purchase or maintain. It also simplifies implementation and upgrading.

#8 What's a typical implementation like?

We’ve all heard the saying: A team is only as strong as its weakest player. During the sales process, you will more than likely meet many tenured resources from a vendor’s team, but don’t assume that those resources will be assigned to your project. Dig for details on the specific team that will be responsible for your implementation. Ask for bios, resumes and references in order to gauge how much experience each resource has with the vendor’s solution. Confirm how much time it will take to move to a new solution. A large organization may require 6+ months to get up and running. A small practice should be able to get going in a few weeks.

#9 Does your solution offer comprehensive workforce validation?

Delivering quality healthcare takes a village. While many credentialing systems cover physician credentialing, very few have the power to verify your extended workforce. If you operate in a non-acute setting, it’s especially important to choose a system that offers automated primary source verification to track and manage licenses, certifications, and sanctions for the resources that support your physicians. Probe for a solution that maintains a comprehensive database of U.S. physicians, nurse practitioners, physician assistants, allied health professionals, and registered nurses and is frequently updated.

#10 Is your company financially stable and growing?

Given the critical nature of a credentialing solution, it’s important to choose a solution provider that will be around for the long haul. Be sure to investigate whether your vendor is:

• Public or private?
• Independent or backed by a strong parent company?
• Acquiring new customers?
• Growing overall?
• Investing in R&D?
• Expanding operations and teams?

At VerityStream, when we help our clients determine whether a Payer Credentialing Solution is right for them, we help them weigh a lot of options – we’d like to help you do the same. Check out our guide on: How to Build a Case for Investing in a Medical Group Payer Credentialing Solution.