4 Steps to a Better Provider Credentialing Process

Streamline your provider credentialing process in 5 key steps. Discover best practices for efficient enrollment and medical credentialing.
A physical therapist with long brown hair works with a patient, who is sitting. Illustrating the topic of the provider credentialing process.

Patients rely on skilled, experienced providers to help them heal. When they’re already in pain, the last thing they need is to be treated by someone who isn’t fully qualified to deliver the care they deserve. Ensuring your providers are thoroughly vetted and credentialed is essential to your patients’ recovery and your practice’s reputation.

However, according to recent studies, credentialing-related denials are on the rise, posing a significant risk to payer compliance and, in turn, your revenue. 

But there’s good news—refining your provider credentialing process can reduce these risks, minimize errors, and create smoother operations. Here’s how to get started.

1. Refine Your Provider Credentialing Process

The first step is to establish a clear, well-defined credentialing process. This should encompass everything from the initial application to ongoing recredentialing. Here’s a basic framework:

  • Gather Required Documents. Work with each provider to collect all necessary documents, such as licenses, certifications, malpractice insurance, and references.

  • Primary Source Verification. Verify the authenticity of all credentials with issuing bodies. This can be a tedious task – more on that later!

  • Application Submission. Complete and submit enrollment applications for each participating insurance company.

  • Monitor Progress. Track the progress of each application with different payers, following up as needed.

  • Maintain Records. Keep a centralized repository of all credentialing documents for easy access and future reference.

  • Recredentialing. Proactively manage credentialing expirations and ensure timely renewals.

By outlining your process and assigning clear ownership for each step, you can avoid delays and ensure a smoother journey for new providers.

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2. Automate Time-Consuming Credentialing Workflows

Credentialing can be a significant administrative bottleneck, pulling your staff away from patient care and revenue-generating activities. Automated credentialing software can streamline tasks like primary source verification, tracking expiration dates, and managing payer enrollment.

Primary Source Verification

Primary source verification (PSV) confirms the accuracy of a provider’s credentials by contacting the issuing authority. It’s an essential step in the credentialing process that confirms a physician can legally practice at an institution.

Manually verifying healthcare provider credentials can be a long, drawn-out process. Automation software simplifies things by automatically checking licenses, certifications, and malpractice records against official sources to help prevent errors and speed up the verification process.

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Tracking Expirables

One of the biggest challenges in credentialing is tracking expiration dates for licenses and certifications. Missing a deadline can lead to providers being unable to practice or bill for services. Automated systems can send you reminders before expirations occur, ensuring you’re never caught off guard.

Managing Tasks and Deadlines

Credentialing involves multiple parties and numerous steps, each with strict timelines. Credentialing software often includes task management tools that provide a clear overview of tasks, deadlines, and responsibilities. This helps you stay organized and avoid missing important deadlines.

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Schedule Blocking

One important feature of credentialing software is the ability to block scheduling for providers who aren’t fully credentialed with certain payers. This feature prevents your team from from inadvertently booking appointments with uncredentialed providers, which could lead to claim denials.

By automating credentialing workflows, you can reduce the manual workload, minimize errors, and significantly reduce the time it takes to credential and enroll your providers. As Bill Sillar, Vice President of Business Development at Raintree, mentions in a recent podcast discussing Provider Credentialing and Enrollment Best Practices: “Reducing manual tasks also decreases the error rate,” which is crucial for maintaining a smooth credentialing process.

3. Centralize Document Management

Staying organized is key to a smooth credentialing process. But let’s be honest; keeping track of paper forms, hunting down signatures, and ensuring all documentation is current can feel like an endless struggle.

That’s why a centralized document management system where all provider credentials and supporting documents are stored securely in the cloud makes so much sense. No more digging through file cabinets or chasing down missing paperwork. 

This centralized approach streamlines the credentialing process and enhances compliance by ensuring all necessary documentation is readily available during audits or payer reviews. It also provides peace of mind, knowing nothing is missing or outdated, which could otherwise lead to costly delays or denials.

4. Make it Easier for Your Team to Collaborate

Credentialing is rarely a solo endeavor—it’s a team effort that requires clear communication and collaboration. Without the right tools, things can fall through the cracks, leading to miscommunication, missed deadlines, and delays in provider enrollment.

Proactive alerts from task management tools keep everyone on time and on the same page. Imagine a system sending automatic notifications when deadlines approach, assigning tasks to specific team members, and providing a platform for open communication that lets everyone know what needs to be done and when. 

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These tools also help bridge the gap between your credentialing team and other departments, like your front office or HR staff. This keeps everyone aligned as you work toward the same goal, streamlining the provider enrollment process and creating a more efficient work environment.

How Improved Credentialing Processes Drive Better Outcomes

To successfully start or maintain a practice, it’s crucial your providers are properly credentialed, recredentialed, and enrolled with payers. Relying on outdated, manual processes can lead to significant challenges, wasting valuable staff time and jeopardizing both revenue and patient care—outcomes no practice can afford.

The benefits of a streamlined credentialing process are numerous: improved efficiency, reduced risk of errors and delays, faster onboarding for new providers, and ultimately, a healthier revenue cycle for your practice. Plus, it protects your practice’s reputation and helps patients receive the quality care they deserve.

Raintree’s built-in credentialing solution offers a unique advantage for rehab therapy practices. By providing a centralized solution within the EMR platform, Raintree’s credentialing management solution can help your practice automate and centralize:

Blogs are created for educational and informational purposes only.  The information provided does not constitute or, is not intended to constitute, legal or medical advice. When you read this information, visit our website, or access our materials, you are not forming an attorney-client, provider-patient, or other relationship with us.

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Last Updated:
October 8, 2024

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