2021 Trend Alert: Leveraging Provider Data to Simplify Physician Credentialing

March 11, 2021 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Medical Credentialing

doctors standing in a row

As 2021 is underway, one of the driving trends of the year is integration. In every facet of healthcare - whether resource savings, mergers and acquisitions, and eliminating redundancies - the importance of integrating healthcare providers with insurance providers has been a clear path to driving medical practice revenue.

If your medical practice is seeking ways to streamline processes to cut back on time and energy it’s time to scrutinize your physician credentialing and insurance enrollment practices. More often than not, these two necessary processes for receiving reimbursement require the same provider data. By implementing these best practices, you can reduce redundancies in both credentialing and enrollment, improving your overall efficiency and increasing revenue. 

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What is Physician Credentialing?


Physician credentialing is the process used by payers to organize and verify the practice history and professional records of physicians. The typical process involves data collection, source verification, and committee review to verify the onboarding physician’s education, training, residency, licenses, malpractice coverage, clinical judgment, and any certifications related to their specialties. 

Medical credentialing allows healthcare practices to accept patients that possess health insurance. While payer enrollment is the process of requesting enrollment in a healthcare insurance panel and plan, credentialing allows the physician and medical practice to be approved by the health insurance company. While it’s a complex process, medical credentialing allows medical practices to enjoy proper reimbursements and on-time payments from their contracted third-party payers. 

How Provider Data Can be Leveraged to Align Physician Credentialing and Enrollment Functions

Typically, physicians at private practices submit their medical credentials during the enrollment and credentialing process when starting a new practice. As more physicians would be hired, they also would file enrollment applications with patient’s insurance providers. Today, the ability to merge credentialing and enrollment with staff functions can create greater efficiency for private practices as the landscape becomes more competitive. Since physicians generally enroll with anywhere between 20 - 25 insurance payers, the insurance enrollment process can extend anywhere from 90  -120 days depending on the insurance payer. To implement a streamlined credentialing and enrollment process, healthcare practices should provide resources and the right processes in place to successfully manage efficient credentialing and enrollment. 

By closely aligning both credentialing and enrollment, your medical practice can not only save time, but also revenue. Most healthcare providers are seeking to reduce costs while maintaining or improving the quality of care. Redundant tasks, such as those involved in physician enrollment and onboarding, are taking up valuable time - contributing to possible revenue loss. Since many of the tasks are similar, leveraging provider data for a closer alignment of enrollment and credentialing can eliminate time-consuming redundancies. 

For example, the credentialing process involves receiving and validating all of the healthcare practitioner’s board certifications, fellowships, academic backgrounds, and any other parts of their career history. Generally, all this data is gathered before any enrollment applications are submitted to insurance providers. Since the enrollment process is several months, having all the paperwork and provider data complete and all necessary applications submitted to the insurance company in advance of the physician being credentialled can help reduce any needless delays.  

So, how to align your physician credentialing and enrollment processes for efficiency? Start by reviewing daily task descriptions with enrolling and credentialing and see where they overlap.  For example, your medical practice should ask the questions:

  • Can the two processes share a database of physician information?
  • Is there the proper documentation in place to gather and manage provider data, such as vendor credentialing and medical billing software?
  • Are there any administrative tasks associated with credentialing, enrolling, and onboarding a physician that are redundant?
  • Are there multiple interviews, background checks, and reference checks that can be streamlined into one process instead of duplicated across departments?
  • How can other departments utilize data transparency to speed up processes and remove any time-wasting duplication?

These best practices can help better integrate these two functions, further eliminating time-consuming redundancies and increasing efficiency and your medical practice revenue potential. 

5 Additional Tips for Simplifying Physician Credentialing


Implement these additional best practices to provide the most streamlined physician credentialing process

Don’t Delay the Physician Credentialing Process 

Get started as soon as possible on physician credentialing! Procrastinating credentialing will only extend the 90-day or so process. Delaying credentialing will only hurt your practice’s productivity, so try and start credentialing as soon as your new physician is onboarded. 

Use the Right Software

Utilizing the right credentialing software platforms can not only streamline your physician credentialing process and reduce human errors that can cause delays. Besides improving overall efficiency, software platforms can take care of much of the hassle out of the physician credentialing process and can leverage valuable provider data across departments to fix any redundancies during enrollment and credentialing. 

Be Proactive On Enrollment Initiatives

A successful healthcare provider enrolment process needs to be proactive about completion. This means continuously following up on overdue or pending claims and applications. Medical practices that follow up and implement efficient credentialing and enrollment solutions make gaining revenue a high possibility. 

Review All Documentation

Inaccurate or missing information can further delay the physician credentialing process. Make sure to review each payer’s application thoroughly and double-check all required information to check for inaccuracies. Even the smallest errors, such as an unchecked box, can set back the process - costing your medical practice valuable time and energy. 

Utilize CAQH

The non-profit alliance Coalition for Affordable Quality Healthcare (CAQH) has a uniform credentialing program so physicians who regularly update and attest with CAQH will have a streamlined credentialing and re-credentialing experience compared with the conventional physician credentialing process. Additionally, CAQH asks for minimal information from your practice during the registration process and handles sending any enrollment information to the payers you select. 

Transform the Physician Credentialing Process at Your Medical Practice with NCG!

Physician credentialing and enrolling doesn’t need to be as time-consuming as it’s made out to be! By streamlining those processes and removing redundancies, you can increase productivity throughout your practice operations and increase your overall revenue. By implementing the above steps, your medical credentialing can be as effortless as possible. 

Your medical practice can further enhance its medical credentialing by seeking the help of outside professional credentialing services. By trusting your credentialing to the experts, you can be confident it’s being handled efficiently and accurately - the first time around. 

Our professionals at NCG Medical are specialists in custom revenue cycle management who can take care of the complicated credentialing process so you can focus on what matters most: delivering care for your patients. Contact our team today and see how our physician credentialing services can transform your medical practice!


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