Your provider credentialing software is your source of truth
What is Credentialing?
Credentialing — also called medical, provider or physician credentialing — is a detailed process that reviews a care provider’s qualifications and career history including their education, training, residency and licenses, and specialty
certificates. Credentialing must be completed upon the hire or enrollment of a new care provider and regularly to abide by the standards set forth by regulatory and accreditation organizations including the National Committee for Quality Assurance
(NCQA) and The Joint Commission (TJC). Credentialing software can help your organization meet these standards and accelerate the process through automation.
Your processes are only as good as the freshness of your information. During the
credentialing process you will request, gather, and validate information about a care provider with the intention of using that information within a downstream process. You need credentialing software that provides you with a powerful ecosystem. A
modern, on demand, cloud-based platform featuring embedded, continuously updated, evidence-based content and curated, crowd-sourced, pre-validated provider data is key to maintaining an unparalleled source of truth that prepares you not only for today,
but for tomorrow.
Curated data
Data is the lifeblood of your business. Good data leads to good decisions that will improve patient care and increase revenue. Your provider credentialing software should automate your credentialing processes with on-point curated data.
- Pre-validated provider data
- CAQH integration
- Primary source verifications including; OIG, SAM, DEA, SSDMF, Medicare/Medicaid, and more with continuous monitoring
Evidence-based content
Your credentialing solution should enable you to automate other important processes in your organization like privileging and enrollment to accelerate enterprise standardization. This should include evidence-based content.
- Intuitively formatted privilege delineation forms with ICD-10 and CPT codes, and FPPE requirements
- A standard indicator library featuring definitions
- Peer Review
- Expirables tracking
- Pre-built workflows
- Continuously-updated, pre-formatted payer forms
- Library of online applications
Provider satisfaction
Today’s providers want to focus on patient care—not providing redundant data. When it comes to physician credentialing, your software solution needs to deliver a superior provider experience.
- A provider-facing hub
- Electronic forms and signatures
- CME tracking
Exceptional user experience
The data collected by your provider credentialing software will be required in downstream processes involving a wide range of users. You need a solution that is easy to learn and easy to use and can be accessed anywhere/anytime.
- Rapid implementation
- Total portability – a cloud-based SaaS solution
- Version control and continuous enhancements
- An easy-to-understand interface
- A powerful automation engine