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View All ProductsOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsFinally, a comprehensive resource to support collecting, storing, and sharing credentialing data with ease.
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View All ProductsMitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.
Learn MoreCredentialing is the process by which organizations obtain and evaluate documentation regarding a medical provider's education, training, work history, licensure, regulatory compliance record, and malpractice history before allowing that provider to participate in a network. Provider credentialing is foundational to healthcare and is clinically and financially essential. Credentialing mistakes can result in increased legal liability and delayed or lost revenue.
Issues and Challenges to Successful Credentialing Programs
1. Evolving Requirements - An evolving business environment, such as healthcare, means changing requirements in how healthcare organizations manage their credentialing processes. Public reporting and increasing levels of scrutiny led the National Committee for Quality Assurance (NCQA) to develop a set of standards that now drive the provider credentialing process. Their requirements have added some rigor to the process by requiring that the organization verify with the primary source when verifying degrees, diplomas, or certificates. Copies are no longer sufficient to satisfy the requirement. Having people and processes that are committed to addressing the evolving nature of credentialing along with the increasingly rigorous requirements is essential to the accuracy and efficiency of the process.
2. Resource Requirements – Payers and other organizations that supply the information that is critical to the credentialing process have their own standards for processing requests. Because these timelines are different from one another, and in some cases, longer than what we might anticipate, it is difficult to estimate completion dates for credentialing. This can make tracking provider progress through the process somewhat difficult.
Even if the information required for credentialing is made readily available, the process is still fairly laborious and requires real attention to detail and a great deal of work, disciplined processes and meticulous record-keeping. Having software and processes dedicated to credentialing can help minimize errors and shorten timelines.
3. Managing Additional Requirements – Your organization may be in a state that has additional credentialing requirements. Make sure that credentialing staff understand the unique requirements of your location and that any additional steps that might be necessary are built into your processes. Credentialing software should also address the unique requirements of your state.
4. Failure to Address Requirements for Updates – Providers need to update their licenses and other credentials regularly according to the requirements of the state in which they are practicing. In addition, processes to capture interim changes in information like phone numbers and other contact information must be in place. Processes that are systematic in
tracking required updates and people who are attentive to detail in their management of these processes are critical to the success of a credentialing program.
5. Incomplete Provider Applications – The credentialing process can be daunting for the provider as well. The applications can require enormous amounts of information and incomplete information may cause an application to be rejected. Software and processes that verify full and complete applications can make the process faster and more efficient.
In the midst of continual healthcare change some things stay the same, like the need for comprehensive provider credentialing, privileging, and enrollment processes. In today’s value-based environment, operational efficiency is critical. Conducting manual verifications, completing paper forms by hand or taking time to deliver files to various locations across the hospital or the system is not cost-effective. Learn about making VerityStream your comprehensive provider solutions partner.
When you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsHealthStream’s learning management system and healthcare training solutions support medical training initiatives and allow for the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementComprehensive, industry-leading provider onboarding and credentialing software that validates health outcomes and supports provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
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