With so many moving parts, figuring out how much credentialing costs can feel overwhelming. For healthcare organizations, the price of credentialing is often more complex than a flat rate. Many factors impact the total costs of credentialing, including how long it takes to complete the process, staff salaries, and any third-party services that may be used.
This guide will break down the costs associated with credentialing to provide valuable insights to help organizations streamline the process and keep costs as low as possible.
Azulity’s provider credentialing services can help healthcare organizations optimize their credentialing processes to reduce costs and improve overall efficiency. Our innovative data management solutions allow organizations to achieve their goals and deliver quality care to their patients.
Is The Cost of Credentialing Worth It?
Medical credentialing is the rigorous procedure of verifying that a physician possesses the necessary qualifications and experience to perform their job competently and safely. This process involves many steps, including:
Primary source verification
ensures that a physician’s educational and training credentials are authentic and up-to-date.
Exclusion checks
Ensure that the physician is not on government or industry exclusion lists for prior malpractice.
Payer enrollments
are necessary to ensure a physician is approved to provide services to patients covered by various health plans.
Privileging
is when a physician has permission to perform specific medical procedures or services.
Recredentialing
is the periodic renewal of credentials to ensure ongoing compliance with regulatory and quality standards.
By completing these steps, hospitals and healthcare institutions can have confidence that they’re working with qualified and competent physicians who meet the highest standards of patient care. However, it’s worth noting that this process can be time-consuming and expensive.
Why Is Credentialing So Important?
Credentialing increases trust
Verifying the qualifications of hospitals and healthcare agencies assures patients of a healthcare professional’s merit and experience. This allows them to place their trust in their chosen providers.
Prevent losing revenues
Credentialing can help prevent medical practices from losing money in lost revenue from delayed or denied reimbursements. To clarify, paying attention to receiving proper credentials can result in insurance payers failing to reimburse medical practices for their treatments.
Lowers the risk of medical errors
It is estimated that about 98,000 Americans die from medical mistakes every year. This alarming number forces industry leaders to push for better standards of exposure and competency to disciplinary measures against healthcare professionals. Credentialing for healthcare facilities and independent practitioners lowers the risk of medical errors.
Protects you from lawsuits
Having an accurate and complete record of every practitioner’s credentials will be helpful in litigation. For example, you can save yourself if there is a negligence claim against a healthcare professional in your institution. In short, you can save your facility from a lawsuit by confirming that you verified all of their credentials as required.
Credentialing with Insurance Networks.
The process takes patience and time. First, you have to decide to proceed. Second, you must shortlist the insurance companies you want to work with. Finally, it’s time to take the first step. Knowing that the credentialing procedure may take a few months is essential.
Related Reading
- Best Credentialing Software
- CVO Credentialing
- How to Credential a Provider
- Credentialing in Healthcare
- How Long Does Credentialing Take
How Much Does Credentialing Cost
Credentialing is a critical process for healthcare organizations. The costs associated with it can vary depending on some factors, including the current credentialing status of the organization, the number of providers to be credentialed, the growth rate of the practice, the number of payers with which the organization is enrolling, changes in insurance contracts, and more. Physician credentialing costs approximately $2,000-$3,000 per year. Here’s a breakdown of the costs associated with individual pieces of the credentialing process: Individual physician credentialing costs between $100-$200 per physician.
Most insurance and facilities require re-credentialing every two years, which may vary. The CAQH Proview database is an option for online provider data collection. The initial setup cost is $200-$500, and essential database management can cost around $50-$100 per month, depending on the level of involvement from the credentialing provider. Insurance panel applications usually cost around $100-$200. These costs add up fast; however, they’re nothing compared to the costs that can accompany the fines and fees following the mistakes of an uncredentialed physician.
What’s the Cost of In-House Credentialing?
Medical credentialing is a necessary process you can do in-house using a team of professionals. According to Salary.com, the average medical staff credentialing specialist salary in the United States is $44,861. Depending on the number of providers, locations, and payers, you may need to hire multiple specialists and support staff—factor in office space, equipment, benefits, training, retention, and replacement costs.
An organization’s credential often has many other responsibilities, such as scheduling, billing, negotiating contracts, human resources, etc. Given the time-consuming and demanding nature of the credentialing process, an efficient process may come at the expense of other essential tasks in a busy healthcare environment.
What About Credentialing Software?
Cloud-based credentialing software offers the ability to manage unlimited candidate data online in one platform, making it much easier to access and track. The best credentialing software also offers automations (such as exclusion checks and license verifications) to keep your workflows on track. These time-saving automations, combined with automatic reminders and all credentialing data in one place, can reduce credentialing timelines by up to 50%. While you will pay for the software, your credentials will be able to get more accomplished in less time, so you may save money if your providers are credentialed and enrolled with payers more quickly.
What Are Outside Credentialing Services?
Outsourcing credentialing services means that a third-party service takes care of all (or most) credentialing tasks, including primary source verification, payer enrollments, facility privileging, and re-credentialing, among other things. This option may seem like the highest cost initially, but consider all employment costs of having someone in-house and the speed with which a team of outside credentialing specialists can work. Here’s an overview of the different kinds of credentialing and their potential costs:
Provider Credentialing
This involves verifying healthcare professionals’ qualifications and ensuring they meet the necessary standards to provide care.
Cost
- In-house Credentialing: $3,000–$5,000 per provider annually (includes staff salaries, software, and resources).
- Third-party Services: $200–$600 per provider, per application. Initial Setup Fees: Some companies charge a one-time setup fee, ranging from $500–$1,000 per provider.
Facility Credentialing
This is for healthcare facilities (e.g., clinics, hospitals) to be approved by insurers and accrediting bodies.
Cost
- Accreditation Fees (e.g., Joint Commission, AAC): $10,000–$50,000 depending on the facility size and type.
- State Licensure Fees are $1,000–$5,000, depending on the state. Consulting Services are $5,000–$15,000 if using external help.
Insurance Credentialing
This is for enrolling providers or facilities with insurance companies to become in-network.
Cost
- In-house Management: Costs include staff time (approximately $40,000 annually per credentialing specialist).
- Third-party Credentialing Services: $500–$2,000 per payer, per provider.
Continuing Education Credentialing
Healthcare providers may need to maintain or renew credentials through ongoing education.
Cost
- Online Courses: $50–$500 per course.
- Certification Renewal Fees: $100–$500 every 1–3 years.
- Specialized Training (e.g., ACLS, PALS): $150–$300 per certification.
Delegated Credentialing
They are used by larger organizations that handle credentialing in bulk for their network of providers.
Cost
- Setup Fees: $2,000–$10,000 for systems and contracts.
- Maintenance Fees: $100–$300 per provider annually.
What Factors Affect the Cost of Credentialing?
Number of Providers
Larger organizations may get bulk discounts.
Specialty
Specialists (e.g., surgeons) often have more rigorous and expensive credentialing.
State and Federal Regulations
Costs can vary depending on specific legal requirements.
Use of Software
Credentialing software costs $100–$500 monthly, depending on features.
Azulity specializes in healthcare master data management and provider credentialing services, bringing proven expertise in implementing healthcare data solutions and credentialing across the US. Our comprehensive platform ensures consistent patient, provider, location, and claims data synchronization across all systems and departments.
Key features include healthcare MDM, provider MDM, reference data management, credentialing, and provider enrollment. We serve healthcare technology leaders—from CIOs and CDOs to VPs of data platforms and credentialing—helping them eliminate the costly problems of fragmented data systems. Book a call to learn more about our healthcare master data management services today!
How To Reduce the Cost of Credentialing in Healthcare
How Credentialing Software Like Azulity Cuts Costs
Azulity focuses on healthcare master data management and provider credentialing services. Our comprehensive platform ensures consistent synchronization of patient, provider, location, and claims data across all systems and departments, eliminating the costly problems of fragmented data systems. Here’s how using Azulity’s credentialing software can cut costs.
Automating Manual Tasks
Credentialing software automates repetitive tasks such as data entry, verification, and follow-up reminders. This functionality decreases the need for full-time staff dedicated to manual credentialing, saving on salaries and administrative expenses.
Streamlining Document Management
Credentialing software centralizes and organizes all credentialing documents, such as licenses, certifications, and malpractice insurance. This minimizes the risk of missing or misplaced documents, reducing delays and potential rework.
Faster Credentialing Process
Credentialing software accelerates application processing and payer enrollment by standardizing and simplifying workflows. This reduces new providers’ time to revenue by enabling quicker approval and network inclusion.
Improved Accuracy and Compliance
Credentialing software ensures compliance with regulations and payer requirements through built-in verification tools and automated alerts for expirations or renewals. This accuracy avoids costly fines, penalties, or service denials due to non-compliance or expired credentials.
Bulk Management for Multiple Providers
Credentialing software handles credentialing for large groups of providers simultaneously with bulk processing features. This saves time and resources compared to credentialing each provider individually.
Integration with Other Systems
Many credentialing platforms integrate with HR, billing, and scheduling systems to reduce duplicate efforts. This eliminates redundancies and ensures smooth data sharing, which saves time and resources.
Reduction of Outsourcing Costs
Credentialing software provides tools that enable in-house teams to manage credentialing efficiently, reducing reliance on expensive third-party services.
Analytics and Reporting
Credentialing software provides detailed reports and analytics to identify inefficiencies and areas for cost savings. This informs better decision-making and resource allocation.
Subscription-Based Pricing
Credentialing software often uses a subscription model, which spreads out costs and is more affordable than significant upfront investments. This avoids the high initial costs associated with custom-built solutions.
Scalability
Credentialing software can scale with your organization as it grows, managing increased provider numbers without proportional cost increases. This ensures long-term savings as your credentialing needs expand.
9 Tips for Efficient Credentialing in Healthcare
1. Leverage Azulity for Streamlined Credentialing
Azulity specializes in provider credentialing services and healthcare master data management. Their comprehensive platform helps organizations eliminate the costly problems of fragmented data systems during credentialing. Features of Azulity’s healthcare solutions include provider enrollment, reference data management, healthcare MDM, provider MDM, and more. By using a platform like Azulity, credentialing becomes a more efficient process with less room for error.
2. Get Ready for the Credentialing Process
The credentialing process involves a lot of paperwork, and it can feel overwhelming. Simply put, the process has two steps:
Credentialing
During the credentialing phase, the insurance company checks all your credentials, verifying that you meet their requirements for participating in their network.
Contracting
The contracting phase is where the company issues you a participating provider agreement, defining the terms of participation for receiving in-network reimbursement for your claims.
3. Prioritize Applications by Insurance Company
Because you could be required to submit many applications, it could be beneficial to prioritize the dossiers you file first. If you send many of your billings to a single insurance company, finish out their healthcare credentialing form first. Stay up to date about individual health insurance rules. Some health insurers enable providers already insured in that other state to undergo a simplified process. This could result in faster approvals. Many insurance providers shortened the application process to providers who have already been credentialed throughout.
Example
A dermatology practice in California saw that 75% of its patients were insured through Blue Cross Blue Shield (BCBS). The practice prioritized submitting the BCBS credentialing form first and coordinated with their support team for a faster review. Meanwhile, for a secondary insurer, Aetna, the provider leveraged an expedited process by proving prior credentialing in another state.
4. Verify All Information is Correct
Remember that accuracy and data standards are crucial when you start compiling the necessary documents and filling out individual applications. Before filing applications, follow these procedures: Run a full background check. Check educational background, licenses, professional certification, and reputation with healthcare groups like AMA, ECFMG, and ABMS.
Examine the credentials, advantages, and health insurance claims background. Once you’ve gathered and reviewed these documents, present them to facility administration, who will decide which particular privileges to give to the provider. This information is crucial for the credentialing process. Other alternatives include:
Credentialing software
The ideal credentialing software saves data and can include features that make your credentialing procedure more straightforward and effective.
Outsourcing
Is your human resources department overburdened with medical credentialing services? Outsourcing or using a medical credentialing service may reduce time and money.
Example
A rural hospital in Texas was onboarding a surgeon. During credentialing, a clerical error caused a mismatch in the surgeon’s medical license number. Additionally, the surgeon’s name on the CAQH profile differed from their license record, so correcting this information was delayed a month.
5. Complete the CAQH Application
Several large medical insurers mandate partner clinics to register for CAQH accreditation (Simultaneously, they must register their applications). Once your clinic has submitted a form to a specific insurer, they will give you a Council for Affordable Quality Healthcare (CAQH) ID number and an invitation to register. Any information must be correct to ensure CAQH clearance. Be ready to re-attest following submitting your initial application. What is re-attestation? – To hold ongoing insurance eligibility, one must verify whether a provider’s data is accurate 4 times yearly.
Example
A pediatric clinic in Ohio received a CAQH invitation after applying for credentialing with Humana. The clinic missed the first re-attestation reminder, temporarily stalling the approval process. After implementing calendar reminders and assigning a dedicated staff member to manage CAQH updates, they avoided future delays.
6. Collect the Necessary Information
A healthcare facility or health insurance plan asks the provider for information on his or her background, licenses, education, etc. The provider may submit the information in a questionnaire through email or software. Sometimes, the healthcare facility or insurance company works with a third-party company—called a credentials verification organization (CVO)—that works with the provider to gather and verify information. Organizations often hire CVOs to allow for more efficient credentialing.
7. Validate the Information
Often, the facility or insurance company will do the background work. They will directly correspond with licensing agencies, medical schools, and other entities to verify the provider’s information. In other cases, the facility or insurance company may use credentialing software to continuously check information that licensing agencies and other entities make available online. The CVO may also run verification checks.
Many healthcare organizations use collaboration and work management platforms to help them organize and record provider information and get automatic updates when specific credentials expire or need to be re-checked. In all cases, the checks include monitoring reports about medical incidents, malpractice claims, or other information that could raise questions about whether to credential or re-credential the provider.
8. Award the Provider with Credentials
After the organization verifies all required credentials and finds no negative issues, the healthcare facility awards credentials to the provider. After the health insurance company completes a similar process, it can approve the provider as an in-network provider. The insurance company will pay the provider to treat insurance patients.
9. Keep Track of the Process
Don’t wait 5 or 6 months for an insurance provider to contact you. Credentialing medical specialists reveal the importance of continuous follow-ups for quick approval. Develop connections with central insurance business personnel. Developing a good working relationship with management, executive associates, and other staff members could help guarantee that applications are processed quickly. Instead of following up through email to boost response chances, use the phone. If you notice that more information is necessary, compile and check all documentation as quickly as possible.
Example
A family medicine practice in Atlanta used Excel spreadsheets to track credentialing statuses but often missed follow-ups. After a consultant recommended using a credentialing management system (e.g., Modio Health), they automated reminders for follow-ups and document updates. This proactive approach halved their typical approval time with insurers.
Related Reading
- Credentialing and Privileging
- Types of Credentialing in Healthcare
- Hospital Credentialing Requirements
- Provider Enrollment and Credentialing
- Primary Source Verification Credentialing
Book a Call to Learn More About Our Provider Credentialing Services
Credentialing defines assessing and verifying a healthcare provider’s qualifications to determine if they meet the requirements to deliver patient care within a particular organization or network. The process typically examines a provider’s education, training, professional experience, and adverse actions or complaints history. Credentialing helps healthcare organizations maintain quality standards and reduce risk by ensuring qualified professionals deliver patient care.
Why Is Provider Credentialing Important?
Credentialing is crucial for healthcare organizations, providers, and patients. For healthcare organizations, the process helps mitigate risk and maintain quality standards by ensuring qualified professionals deliver patient care. For providers, credentialing facilitates smoother transitions when changing jobs or moving to different locations. The process helps ensure they can quickly resume delivering patient care with minimal disruptions. Finally, credentialing helps protect patients by ensuring they receive care from qualified professionals.
What Is the Credentialing Process?
The credentialing process follows a few steps, including:
1. Application
The provider applies to the healthcare organization or network. This application includes information about the provider’s education, training, experience, and any history of adverse actions.
2. Verification
The organization verifies the information in the application. This process includes checking references, confirming education and training with the appropriate institutions, and reviewing any history of adverse actions with state licensing boards and specialty certification organizations.
3. Decision
After verifying the information, the organization decides on the provider’s application. This decision may involve granting the provider privileges, denying the application, or recommending additional training or education before the individual can receive privileges.
4. Re-credentialing
The organization will re-assess the provider’s qualifications every one to three years to ensure they maintain quality standards.
How Much Does Credentialing Cost?
The cost of credentialing can vary significantly depending on several factors, such as:
The type of credentialing
Provider credentialing, payer credentialing, and clinical privileging have different processes and requirements.
The number of organizations involved
Providers may need to be credentialed by several organizations before seeing patients. For example, a healthcare organization may need to credential a new provider before seeing patients. Then, the provider must be credentialed by the payer to ensure claims are paid. This process may involve multiple steps and organizations, depending on the payer.
The method of credentialing
Credentialing can be done manually, using credentialing software, or outsourcing to a credentialing service. Each option has different costs and time commitments.
The provider’s specialty
Certain medical specialties have more extensive credentialing processes, which can increase the time and costs associated with credentialing.
How Long Does Credentialing Take?
Like the cost of credentialing, the time it takes to complete the credentialing process can vary based on several factors. On average, the credentialing process can take anywhere from 30 to 180 days to complete. The following factors can impact the length of the process:
- Type of credentialing
- Number of organizations involved
- Method of credentialing
- Provider specialty
- Completeness of application
What Happens If Credentialing Is Delayed?
Delays in the credentialing process can lead to negative consequences for healthcare organizations and providers. For organizations, delays can lead to increased risks and costs. For example, delays in credentialing a new provider can prevent the organization from meeting patient demands and negatively impact patient care.
In some cases, the organization may even experience a reduction in revenue. Delays in credentialing can lead to costly disruptions in providers’ care. In some cases, a new provider may lose patients or be forced to make alternative arrangements for care once credentialing is complete. Delays can also result in added stress and frustration for the provider and the organization involved.
Azulity: The Credentialing and Privileging Game Changer
You don’t have to go it alone regarding credentialing and privileging in healthcare. Azulity specializes in healthcare master data management and provider credentialing services, bringing proven expertise in implementing healthcare data solutions and credentialing across the US. Our comprehensive platform ensures consistent patient, provider, location, and claims data synchronization across all systems and departments.
Key features include healthcare MDM, provider MDM, reference data management, credentialing, and provider enrollment. We serve healthcare technology leaders—from CIOs and CDOs to VPs of data platforms and credentialing—helping them eliminate the costly problems of fragmented data systems. Book a call to learn more about our healthcare master data management services today!