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Credentialing providers is one of the most complex and ongoing processes in healthcare. While essential for ensuring patient safety and compliance, the process often becomes burdensome, costly and time-consuming, even with specialized credentialing applications. In this article, we’ll explore how Profisee’s master data management (MDM) solution addresses these challenges, offering a streamlined, data-centric approach to provider credentialing.
The Challenges of Provider Credentialing in Healthcare
Credentialing is a critical function that verifies the qualifications of healthcare providers before they can deliver patient care. Despite the availability of purpose-built credentialing applications from vendors like Symplr, Medallion, Modio and CredentialStream, many healthcare organizations still find the process cumbersome and inefficient.
Even with these advanced tools, the credentialing process often suffers from delays, errors and high costs. The impact of these issues can be severe, leading to compliance risks, delayed revenue recognition, and slow payments from payers. For providers, even a one-month delay in credentialing can result in significant financial losses, with ripple effects that extend across entire healthcare facilities.
Why Credentialing Processes Remain Burdensome
Credentialing remains a challenge primarily because most credentialing software is process-centric rather than data-centric. These tools excel at providing application portals with functions like workflow management, document management and expiration reminders, but they often fall short when it comes to data management.
Key tasks like aggregating provider data from multiple sources, identifying discrepancies and ensuring data accuracy are left to manual intervention. This can require the help of multiple people manually gathering missing data and reconciling discrepancies between records, significantly adding to the time and cost burden.
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The Financial Impact of Inefficient Credentialing
As time goes on, technical debt from inadequate credentialing tools and overhead from increased staffing accumulate, leading to inefficiencies that can have serious financial consequences. According to Health Plan Week, payers and physicians spend over $2.1 billion annually trying to maintain accurate and complete practitioner records.
The delays and errors associated with manual data management can lead to lost revenue, delayed payments and increased operational costs, making it imperative for healthcare organizations to find a more effective solution.
How Profisee MDM Transforms the Credentialing Process
Profisee’s adaptive master data management solution offers a comprehensive approach to streamlining provider credentialing. By focusing on data management, Profisee helps healthcare organizations overcome the challenges associated with traditional credentialing software. Here’s how:
Data Aggregation and Consolidation
Profisee MDM automatically collects, aligns and harmonizes provider data from multiple internal and external sources. This process fills in data gaps and flags discrepancies, reducing the need for manual intervention.
Fuzzy Matching and Record Linkage
Profisee’s configurable fuzzy matching engine can link provider data even when standard identifiers like NPI are missing. This capability ensures that all relevant data is connected, providing a complete and accurate picture of each provider.
Data Quality and Compliance
Profisee MDM enforces robust data quality rules to ensure that provider data meets organizational and industry standards. Records that do not comply are automatically flagged for review, allowing credentialing teams to address issues quickly and efficiently.
Automation and Workflow Integration
Profisee integrates seamlessly with existing credentialing workflows, automating the distribution of accurate, validated provider data to credentialing, HR and payroll systems. This automation accelerates the onboarding process, reduces manual errors and speeds up time to revenue.
The Benefits of Streamlined Credentialing
By leveraging Profisee’s MDM solution to simplify their healthcare credentialing process, organizations can realize significant benefits, including:
- Faster Onboarding and Credentialing: Reduce the time it takes to credential new providers, allowing them to start performing billable activities sooner.
- Improved Provider Experience: Enhance the experience for providers by minimizing delays and errors in the credentialing process.
- Reduced Provider Attrition: Simplify credentialing to make everyone happier — especially providers, who are less likely to leave with fewer obstacles between them and providing quality care to their patients.
- Increased Revenue and Reduced Costs: Accelerate revenue recognition and reduce the operational costs associated with manual data management.
- Optimize Insurance Payment Approvals: The faster and more efficiently you can credential providers, the faster insurance companies can make payment approvals.
- Compliance and Risk Mitigation: Ensure that all provider data meets regulatory standards, reducing the risk of compliance issues.
Make Provider Credentialing Easy with Profisee
Streamlining the provider credentialing process is critical for healthcare organizations seeking to improve efficiency, reduce costs, and enhance provider satisfaction.
For this reason, it is important to be judicial and selective when deciding to take on incremental use cases to an existing MDM implementation. Read our complete guide to Selling MDM to Leadership for tips, best practices and insights that I’ve seen work for MDM practitioners working to expand their MDM program into multiple business-centric use cases.
Selling MDM to Leadership
