How to Outsource Credentialing Services

Provider credentialing can be tedious and stressful. No healthcare organization wants to rush through the process for fear of missing critical information that could impact patient safety.

Outsourcing credentialing services can lighten the load by giving organizations access to external teams that manage the data for them.

This guide will explore how outsourcing can allow healthcare organizations to manage data innovatively and alleviate the burdens of provider credentialing.

Azulity’s provider credentialing services are an effective way to achieve your goals. Our solution streamlines credentialing, helping healthcare organizations mitigate patient safety risks while improving operational efficiency.

How to Outsource Credentialing Services

man with a laptop - Outsource Credentialing Services

Assess Your Needs: What Credentialing Services Do You Need?

The first step to outsourcing credentialing services is to assess your needs. This means determining the volume of credentialing required (e.g., number of providers or organizations involved); identifying the types of credentialing services needed, such as initial verification, re-credentialing, or ongoing monitoring; and evaluating internal challenges, such as compliance requirements, timelines, and resource constraints.

Research Credentialing Service Providers: Find a Reliable Partner

Next, research credentialing service providers. Look for companies with expertise in your industry (e.g., healthcare, legal, or educational sectors). Check their track record, client testimonials, and reviews. Ensure they have the necessary certifications or accreditations (e.g., NCQA, URAC) to meet regulatory standards.

Evaluate Technology and Compliance: Ensure You’re Protected

Before outsourcing credentialing services, evaluate potential partners’ technology and compliance. Confirm that the provider uses secure, modern technology platforms for credentialing. Assess their ability to comply with relevant laws, such as HIPAA for healthcare or GDPR for data protection. Ask about data security measures and backup systems.

Request Proposals: Compare Pricing and Services

Once you’ve narrowed your options, issue a Request for Proposal (RFP) to outline your needs, timelines, and budget. After you receive responses, compare providers based on cost, experience, technology, and customer service.

Verify Their Processes: Know What to Expect

Before choosing a credentialing service, verify its processes for managing credentialing tasks. Understand its workflow for verification, data management, and reporting. Ensure it performs primary source verification (PSV) and meets industry-specific accreditation requirements. Confirm it provides regular updates and reports on credentialing progress.

Negotiate the Contract: Address Terms to Avoid Future Headaches

Once you’ve settled on a provider, negotiate the contract. Review terms, including service levels, pricing, timelines, and confidentiality agreements. Include clauses for quality assurance, dispute resolution, and termination conditions.

Integration and Onboarding: Prepare for a Smooth Transition

Prepare for the integration and onboarding of your new credentialing service. Ensure the provider can integrate with your existing systems, such as HR or billing platforms. Establish clear communication channels and designate a point of contact from both sides. Train your team to collaborate effectively with the outsourced provider.

Monitor and Evaluate Performance: Keep Your Provider Accountable

After outsourcing credentialing services, it’s essential to monitor and evaluate performance. Set KPIs to measure the success of the credentialing process, such as turnaround times, error rates, and compliance adherence. Regularly review performance reports and provide feedback. Schedule periodic reviews to reassess needs and improve processes.

Transition and Scalability: Prepare for Future Changes

Finally, plan for transition and scalability. If you switch providers or bring credentialing in-house, prepare for a smooth data handoff. Choose a provider that can scale services as your organization grows, or compliance demands increase.

Pros and Cons of Outsourcing Credentialing Services

The Benefits of Outsourcing Credentialing

Outsourcing credentialing can significantly reduce the administrative burden for healthcare providers, allowing staff to focus on patient care. By partnering with specialized external providers, healthcare facilities save on costs and improve operational efficiency. Let’s explore these benefits in detail.

Alleviating the Administrative Burden

Outsourcing credentialing can significantly reduce the load of administrative tasks that healthcare organizations face. By transferring these responsibilities to specialized external providers, healthcare facilities can achieve substantial cost savings and more streamlined operations.

This shift allows internal staff to focus on more critical areas rather than getting bogged down by the cumbersome details of the credentialing process, which includes constant updates and renewals of provider licenses and certifications.

Equipping Expertise and Enhancing Patient Safety

One of the most compelling advantages of outsourcing credentialing is access to specialized expertise. Credentialing services are well-versed in the latest healthcare regulations and are adept at ensuring compliance.

This expertise mitigates the risk of accreditation issues and enhances patient safety, a paramount concern for healthcare providers. These external teams are detail-oriented and dedicated to maintaining the highest provider qualification and regulatory adherence standards.

Boosting Operational Efficiency

The efficiency gained through outsourcing can lead to quicker provider onboarding, meaning healthcare services become available to patients faster than they would with in-house credentialing processes.

Outsourcing credentialing also frees up valuable resources, enabling healthcare providers to concentrate more on patient care than administrative duties. This shift in focus can lead to better patient outcomes and higher satisfaction rates, as providers can spend more time with patients and less on paperwork.

Scalability

Outsourcing credentialing also offers the flexibility to scale healthcare operations according to current demands without the complexity of hiring or laying off staff. This adaptability ensures that organizations can efficiently manage fluctuating workloads, facilitating growth or contraction as needed, without the burden of adjusting internal workforce levels. This can lead to better resource management and cost efficiency across the healthcare spectrum.

The Challenges of Outsourcing Credentialing

Healthcare organizations face various credentialing-related challenges ranging from concerns over control and communication barriers to ensuring top-notch security. Let’s explore the top four challenges healthcare organizations face when outsourcing credentialing services.

Navigating Loss of Control

A significant concern with outsourcing credentialing is the potential loss of control over critical processes. Healthcare organizations might feel detached from integral operations, affecting their ability to effectively oversee and manage the credentialing process.

This loss can lead to operational transparency uncertainties and affect decision-making capabilities concerning provider approvals and denials.

Overcoming Communication Barriers

Effective communication is vital in any outsourcing relationship. Differences in time zones, languages, and business cultures can introduce barriers that complicate the coordination between healthcare organizations and their outsourcing partners.

Establishing clear lines of communication, regular updates, and transparent processes is crucial to mitigating these challenges and ensuring a smooth operation.

Addressing Security Concerns

Handling sensitive provider information raises legitimate security concerns when outsourcing credentialing. The potential for data breaches or unauthorized access to sensitive documents is a risk that healthcare organizations must consider.

Ensuring that the outsourcing partner has robust security measures and protocols in place is essential to protecting patient and provider data, maintaining trust, and complying with health regulations.

Dependence on Service Provider

Reliance on external credentialing providers carries risks, such as service disruptions if the provider’s quality declines or they cease operations unexpectedly. This can delay essential processes like provider onboarding, affecting patient care. Maintaining some in-house capability can mitigate these risks and ensure continuity.

How Does Azulity Help With Hospital Credentialing Requirements?

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!

When to Outsource Credentialing

1. Limited Resources Slow Down Operations

More resources are needed to improve operational efficiency. This issue commonly occurs in small and medium-sized practices with minimal administrative staff. These professionals need more knowledge and experience to manage credentialing. Outsourcing helps to alleviate any problems caused by limited resources. The external credentialing service can take over the process quickly and ensure everything runs smoothly. This improves efficiency and allows the in-house team to focus on more pressing matters.

2. Lack of Expertise Delays the Credentialing Process

The credentialing process is tedious and time-consuming. It requires specialized knowledge and expertise to navigate the maze of verification and documentation. If a provider organization lacks in-house expertise, the credentialing process can become painful, resulting in significant back-and-forth correspondence. Outsourcing credentialing to an experienced vendor will ensure timely and accurate results.

3. Regulatory Compliance Changes

Regulatory compliance is an essential aspect of credentialing. Requirements vary by state, region, and payer. Additionally, they change frequently. Keeping up with these ever-shifting standards can be overwhelming for an organization’s administrative staff, especially when they are already busy handling daily operations. Outsourcing credentialing to a specialized vendor helps relieve this pressure. Credentialing companies have teams focusing on regulatory compliance, so you don’t have to.

4. Scalability Without Compromising Internal Processes

As a healthcare organization grows, so does the complexity of its credentialing processes. Outsourcing to a vendor helps manage the increased workload without overburdening internal staff. This can help maintain efficiency and business operations and minimize the risk of staff resignations or burnout. Finding replacements for practice administrative personnel can be challenging today’s economic climate, and credentialing should not contribute to staff turnover.

5. Risk Management

Credentialing plays a crucial role in patient safety and quality care. Although it doesn’t happen often, a single error in the credentialing process can have severe consequences. Outsourcing to a third party can help mitigate these risks by ensuring proper verification of healthcare professionals and maintaining compliance with regulatory standards.

13 Best Practices for Smooth Credentialing Outsourcing

1. Identify Your Objectives Before Outsourcing Credentialing Services

Before initiating the shift to outsourced credentialing services, defining your organization’s specific goals is critical. Determine what you hope to achieve through this transition. Common objectives might include reducing administrative burdens, enhancing credentialing efficiency, ensuring compliance with regulatory requirements, and improving the overall quality of care. Establishing clear goals will help guide your decision-making throughout the transition process.

2. Choose the Right Credentialing Partner

Selecting the ideal credentialing partner is a pivotal choice. You want to collaborate with an experienced and reputable outsourcing provider with a solid track record in medical billing services credentialing. Research potential partners, evaluate their qualifications, and speak with references to ensure they can meet your specific needs. Consider their technology capabilities, turnaround times, customer service, and pricing structure.

3. Create a Transition Plan

A detailed transition plan is essential for a smooth shift to outsourced credentialing. This plan should include a timeline, tasks, responsibilities, and milestones. Work closely with your chosen credentialing partner to ensure alignment of goals and expectations. The transition plan should also address how data and historical records will be transferred securely.

4. Conduct a Detailed Data Audit

Conduct a thorough data audit before transferring any information to your credentialing partner. Identify all the information and records associated with your credentialing processes, leaving everything to be noticed. Organize the data, verify its accuracy, and clean up any outdated or duplicate records. Data security and compliance are paramount; ensure your partner follows strict data protection protocols.

5. Streamline Workflows

Use the transition to outsourced credentialing as an opportunity to streamline your credentialing workflows. Rethink your current processes and identify areas for improvement. Your partner may have best practices and suggestions to enhance the efficiency of the credentialing process. Implement these improvements to optimize your operations.

6. Staff Training and Communication

Transitioning to outsourced credentialing can lead to changes in job functions and responsibilities for your staff. Providing proper training and communication is essential to ensure a smooth transition. Equip your team with the necessary knowledge and skills to collaborate with the outsourcing partner. Open lines of communication are also critical to resolving any concerns that may arise during the transition.

7. Maintain Compliance

Credentialing is highly regulated in the healthcare industry, with strict compliance requirements. As you transition to outsourced credentialing, ensure your partner is well-versed in these regulations and maintains compliance. Collaborate on compliance audits and reviews to mitigate potential risks.

8. Implement Technology Solutions

Leverage technology to your advantage during the transition. A credentialing management system can streamline the process, centralize data, and improve communication with your outsourcing partner. Implementing a CMS can enhance efficiency, reduce errors, and provide better visibility into the credentialing process.

9. Monitor and Evaluate Performance

Once the transition is complete, it’s essential for ongoing monitoring and evaluation. Continuously assess your partner’s performance against your objectives at the outset. Regularly review key performance indicators to ensure that the outsourced credentialing services meet your expectations.

10. Continuous Improvement

Use the insights gained from monitoring and evaluation to improve your credentialing processes continuously. Work with your partner to identify areas for improvement and implement changes as needed. Be open to feedback and adapt to the evolving landscape of healthcare credentialing.

11. Less Paperwork/Greater Security

HP Credentialing uses Modio Health to collect and store online, secure provider profiles. This allows remote access with easy editing, uploading, and sharing of documents and profile information instead of using filing cabinets.

12. Lack of Expertise Delaying the Credentialing Process

Credentialing can be complex and time-consuming, requiring specific knowledge and expertise. If the provider organization needs in-house skills, the credentialing process becomes incredibly lengthy and tedious, consisting of to-and-fro correspondence. Outsourcing to a specialized vendor can ensure accurate and timely credentialing.

13. Scalability Without Compromising Internal Processes

As a provider organization grows, credentialing can become increasingly complex and cumbersome. Outsourcing to a vendor can help manage the increased workload without overburdening internal staff. Additionally, if the burden becomes overwhelming on existing staff, it could lead to resignations or burnout. On the other hand, finding someone to replace practice administrative personnel or to find new employees to grow the team is tough in today’s economic environment.