4 Common Challenges with Provider Credentialing—and How an All-in-One Automated Solution Can Help

A process as essential as provider credentialing—primarily in place to protect patients—shouldn’t be as complicated as it stands today. Payer enrollment, the multi-step segment of credentialing that connects providers and payers, is particularly complex, and contributes to more than $2 billion spent annually to maintain provider databases. Further, the credentialing process has become more convoluted and time-consuming over the years due to the growing scope of provider practices, accrediting organizations, and requests from Medicare, Medicaid, and private insurers.

Like with any complex process, there are bound to be challenges along the way. When it comes to provider credentialing and payer enrollment, it’s best to find a solution that simplifies the process and increases efficiency.

Let’s review four common challenges with provider credentialing, and how a technology platform—built on in-house innovations, industry partnerships, and custom integrations—automates the manual and error-prone tasks.

Staffing shortages are plaguing the healthcare system and delaying industry improvements. For providers and staff who are already stretched thin, provider data management processes like licensing, credentialing, and enrollment are often a driver of unnecessary administrative burden. Not to mention, multiple steps need to be repeated for each new payer-provider relationship.

Solution: The Madaket platform ensures administrative tasks get done on time and without adding to your headcount. It proactively provides expirable notifications and flexible task management to seamlessly delegate responsibilities between enrollment managers, operations staff, and providers.

Since the credentialing process is still mainly paper-based, it’s painfully slow, causing information to become outdated much quicker than in a digital environment. While filling out forms may seem like a simple, administrative task, the dissimilar processes used by payers, clearinghouses, and other third parties involved creates many opportunities for error. When provider data is out-of-date, missing, or incomplete, it can delay approvals by days or weeks and may prohibit providers from treating patients. Estimates show that an industry-wide source of truth could eliminate up to 75% of costs related to maintaining provider databases.

Solution: When you gather and store your data digitally on the secure, cloud based Madaket platform, you unlock a single source of truth for provider data collection, maintenance, and distribution. The Madaket platform allows you to access up-to-the minute and accurate information for every provider, location, group, and facility.

Payer enrollment is the crucial step in the payer-provider relationship. Without it, providers can’t start billing for services or get paid in a timely fashion. With each payer using different formats, and often requiring the forms to be completed manually, enrollment is a tedious grind that eats up valuable time for providers and staff. Once the paperwork is complete, the 90-to-180-day review process begins. Typically, there isn’t a portal or email system to provide alerts and updates, so staff may spend valuable time following up via phone. In the meantime, the provider is barred from providing care or billing for services in that payer network.

Solution: Access the Madaket platform to quickly initiate payer enrollments, tax ID associations, and new practice locations in our nationwide 4,000+ payer library. The Madaket platform helps make essential provider operations painless, precise, and fast—reducing enrollment preparation time by as much as 85%.

We can’t say it enough—provider credentialing is complex. Standards and guidelines not only vary by payer, but they also vary by state. These differing factors complicate the process due to a wide range of compliance regulations and requirements. It’s not easy to juggle regulatory compliance, keep track of licensure, board certifications, and CME/CMU requirements, and ensure the system you’re using is secure.

Solution: With the Madaket platform, you can track medical licensure, board certifications, and other expirables to keep your providers in compliance. The platform also provides reports that you can exchange with compliance and regulatory agencies. Additionally, the platform is fully SOC 2-certified.

Multiple touchpoints throughout the provider credentialing process and payer enrollment steps can cause the healthcare system to lose significant time and money. Yet so much of the $2 billion annual costs to maintain provider data can be eliminated by automating one or more of the essential tasks in healthcare administration. At Madaket, we manage the complexities of provider data management for you.

To learn about Madaket’s all-in-one, automated solution for provider data management, check out the platform. For more information about credentialing and enrollment, read our Definitive Guide to Provider Credentialing and Payer Enrollment.