With automated credentialing platforms, technology can be leveraged to automatically verify credential information using cloud-based data. (Photo: iStock)

Long before the COVID-19 pandemic, we knew the American health care system was in dire need of a serious overhaul. Beyond the political arguments about access to affordable health care, the way health systems operate has been criticized as been weighed down with administrative waste and other inefficiencies.

Like the other aspects of our broken health care system, the coronavirus pandemic is shedding a light on the problems with health care administration.

Related: 4 recommendations for combating health care’s high administrative costs

Eric Zerneke is chief commercial officer of CredSimple.

Eric Zerneke, chief commercial officer of CredSimple, recently shared some insights with BenefitsPRO about how the next generation of credentialing systems is reforming the health care industry. In his role, Zerneke drives commercial strategy, including spearheading all sales, business development and marketing.

What does the traditional credentialing process look like? How can automated credentialing transform that process?

Traditional credentialing is often a long and tedious process that can take between 60 and 90 days. When automation is brought into the mix, the time needed to properly credential a provider is significantly reduced, enabling greater efficiency and productivity for applicable teams.

Information is first gathered from a provider using an application, which a health plan or CVO then uses to verify a provider’s credentials such as licenses, education, work history and more. In some cases, specific information is missing or incorrect when working through a credentialing process. When this problem arises, the party doing the credentialing then needs to conduct additional outreach in order to verify what’s missing.

With automated credentialing platforms, technology can be leveraged to automatically verify credential information using cloud-based data. These workflows automatically check the provider’s information against existing data points to determine whether the information is correct. This removes the frustrations that are often associated with traditional credentialing and allows all teams involved to credential faster, thereby work more effectively and recognize revenue sooner, all while remaining compliant.

How can automated credentialing reduce health care administration costs?

There are multiple ways that automated credentialing plays a role in reducing healthcare administration costs. One of the biggest benefits is that turnaround times for getting providers credentialed is drastically reduced, which in turn lowers costs associated with having a large team. Files can be turned around in as quickly as five or six days when utilizing automation within the credentialing process. As a result, organizations don’t need to have big groups of people doing that work and providers can begin working with a plan much faster. Having an NCQA-Certified automated credentialing platform also ensures that you’re remaining compliant, reducing risk for the payer.

What sort of tasks and internal processes are impacted by automated credentialing?

Typically, a payer will have an entire team devoted to the credentialing process. With a CVO that turns around files faster, a credentialing team can turn to an automated credentialing provider and focus on more important tasks and processes. The most critical processes that are automated is primary source verification and application review – in which credentials such as licenses and education are confirmed and compliance is ensured.

How can health technology innovations play a role in minimizing workflows? What impact can this then have on the health care industry as a whole?

There is a vast array of workflow processes in health care that can be streamlined through technology. From credentialing to practice management, there are many advantages to leveraging technology in the industry, ultimately allowing professionals to perform their jobs more efficiently and deliver better patient outcomes. Increasing efficiency leads to lower costs. Driving down overall health care costs allows for people to have access to more affordable care.

What role can automated credentialing play in the face of COVID-19?

During COVID-19 the demand for credentialed providers has skyrocketed in order to render care to patients in need. Automated credentialing technology allows payers to add providers at a much greater speed then they could previously in order to meet demand. A specific area where we’re seeing a lot of success with this is telehealth, an industry that was forced to scale rapidly. With this type of technology in place, credentials can be turned around quickly, allowing telehealth organizations to grow and maintain compliance at the same time.

What credentialing trends are you currently seeing?

We’ve seen a large increase in telehealth companies that need to scale quickly and credential hundreds of providers in order to meet demand. With the continued growth and utilization of telehealth services, the need for both quick and compliant credentialing of practitioners in order to provide these services will continue to expand in scope.

In addition to telehealth, most states passed emergency/executive orders to allow practitioners from other states to practice in additional states where they were not currently licensed. Automating the verification process allows practitioners to be eligible to see and treat patients in a much shorter turnaround time while remaining compliant with the emergency/executive orders.

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