Top Five Medical Credentialing Software Companies

When a patient goes to see a doctor, nurse, or any healthcare provider, they automatically assume that person is qualified to give them the care which they seek. Yet there is a long, intricate process that goes into making sure every healthcare provider is qualified to do the job, known as medical credentialing.

For justified reasons, medical credentialing is complex and time-consuming. Without proper software, the process can take weeks and sometimes months to complete. Medical facilities lose an average of $1.2 million in revenue per physician while the healthcare providers lose tens of thousands of dollars in revenue.

While there are many medical credentialing software solutions on the market, it is important to know exactly what to look for in a platform. The ideal software will help a facility maintain compliance and avoid costly fines or potential exclusions while benefitting the individual provider.

Top Medical Credentialing Software Ccompanies in the Industry Today:

1. Intiva Health: Ready Doc™, developed by Intiva Health, is a one-stop-shop software as a service solution for healthcare facilities and their providers. The platform is user friendly with all of a provider’s information securely stored in a centralized repository a few clicks away and protected by Hashgraph Distributed Ledger Technology (DLT). Ready Doc™ is the only credentialing software on the market that simultaneously benefits facilities and individual providers by providing ACCME accredited courses within the same platform where the credentialing process is completed. Healthcare professionals can advance their own careers and meet state medical board licensure requirements by completing accredited CME and CEU courses which consequently benefits the facility which they are associated with. Most credentialing software is designed for facilities or large healthcare systems. By incorporating CME and CEU into the platform, along with automated reporting, automated population of digital forms, automated compliance alerts, along with privileging and appointments, Ready Doc™ is beneficial for everyone involved in the credentialing process.
2. Applied Statistics & Management: MDStaff, by Applied Statistics & Management, is a software that is aimed at hospital management and helps medical practitioners streamline administrative operations with document merging, notifications, reporting, and more.
3. Modio Health: OneView, developed by Modio Health, is a cloud-based platform that focuses on compliance allowing facilities to manage and store their team’s credentials and licenses in one place.
4. Symplr: Symplr Provider focuses on provider data management. The platform works to automate provider credentialing, appointments, privileging, payer enrollment, network management, and peer reviews.
5. Covenant Technology Group: CredentialMyDoc, by Covenant Technology Group, is best suited for multi-provider medical practices, credentialing companies, medical billing companies, and independent physician associations. The software provides document management, expiration management, license verification, and privileging.

Without a software such as the ones listed above, healthcare providers and facility staff spend more than 20 hours combined submitting and verifying credentialing documents. Any human errors, missing forms, or slow replies to verification requests can add weeks and sometimes months to the process. Much of the time is spent simply waiting for documents and the verification of credentials. All of the time spent on the credentialing process is important time that could spent on patient care.

Then consider the fact that the credentialing process needs to be re-done every two years. If a provider’s documents are not securely stored in an organized fashion, it is an endless cycle of lost time, lost revenue, and risking a costly compliance breach.

It is important to note that credentialing is thought of being beneficial only for physicians, however it also has a strong importance for nurses. Credentialing can help to advance a nurse’s career by recognizing achievements and encouraging more professional growth through certification.

In order for nurses or physicians to renew their licenses and certificates, a certain amount of continuing education course hours must be completed every two years in addition to the credentialing process. The number of hours depends on their specialty and the state in which they are licensed to practice medicine.

Physicians must complete Continuing Medical Education courses, also known as CME. However, they cannot simply take any online course and call it a day. The courses must be accredited, often by the Accreditation Council for Continuing Medical Education (ACCME). In turn, these accredited courses earn healthcare providers credits through the American Medical Association PRA Credit System. This system only awards credits for courses that meet the requirements of state medical boards, medical specialty societies, specialty boards, The Joint Commission, insurance groups, and others.

The significance of CME for physicians and CEU for nurses as part of both the credentialing process and licensure renewal is what puts Ready Doc™ at the top of the list.

Summary

Medical credentialing is a standard practice in all healthcare facilities which is crucial for the facility itself, the provider, and their patients. Credentialing is also imperative for payer enrollment and granting privileges to a healthcare provider. Without credentialing, there can be no reimbursement from insurance companies to any facility or physician.

The credentialing process involves the medical facility and a third-party Credentials Verification Organization (CVO) to conduct a thorough review of a provider’s identity, education, work experience, malpractice history, and licenses using primary source verification.

The Joint Commission, also known as TJC, is a nonprofit organization that accredits more than 22,000 healthcare organizations and programs across the United States. The organization defines primary source verification as:

“Verification of an individual practitioner’s reported qualifications by the original source or an approved agent of that source. Methods for conducting primary source verification of credentials include direct correspondence, documented telephone verification, secure electronic verification from the original qualification source, or reports from credentials verification organizations (CVOs) that meet Joint Commission requirements.”

With all of the rules and regulations surrounding credentialing, it is important to consider the size of a facility, the number of providers, their license types, and most importantly how much of an administrative workload is dedicated solely to credentialing when choosing which software is most appropriate.

The ideal medical credentialing software solution will handle all needs of a facility no matter their size while also benefitting the individual providers.