5 Valid Reasons Why Modern Practices Outsource Credentialing Services

Medical Credentialing

Outsource Credentialing Services for Providers

Medical credentialing can be challenging, confusing, and a complicated, time-consuming process. It can lead to delays in providers becoming billable, directly affecting a practice’s revenue potential. However, outsourcing credentialing services for providers can make your practice more efficient and profitable.

This article will explore the challenges surrounding medical credentialing and why many practices prefer to outsource credentialing services instead of keeping this resource-consuming yet essential service in-house.

At Neolytix, we allow you to outsource your credentialing services for a flawless and hassle-free provider credentialing experience. Credentialing is an ideal process for outsourcing because it is a specialized service, repetitive in nature, and requires expertise. It is best to assess your options to outsource this function to a partner specializing in credentialing.

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What is Medical Credentialing?

Medical credentialing, also known as physician credentialing or insurance credentialing, refers to the process of becoming affiliated with an insurance company, also referred to as a payer, to allow healthcare providers to be reimbursed for services rendered.

The process includes verifying elements such as education, training, experience, licensing, former judgments, etc. and may take between 90 to 120 days. The challenge for many practices lies in decreasing this time so that providers can become billable faster and positively impact the practice’s revenue stream.

What is Re-Credentialing?

Recredentialing is the process by which the credentials of an individual who has already been credentialed in the past must undergo the process again. It is typically required periodically, usually every few years, to ensure that the individual’s knowledge and skills are up-to-date and that they are still qualified to be credentialed.

The purpose of re-credentialing is to ensure that certified or licensed individuals continue to meet the standards set by their profession and maintain their competence in their field.

If you wish to learn more about re-credentialing, take a break and watch the video below.

What internal credentialing maintenance entails

outsource credentialing services

These are additional resource-hungry tasks that require expertise and also patience and would be better off if outsourced. Below are the most popular reasons why practices choose to outsource credentialing services.

Why do providers outsource credentialing services?

From our experience, providers may consider outsourcing their credentialing process for the following reasons:

1. Limited resources impeding operational efficiency

This limitation generally refers to small and medium-sized practices. A handful of administration personnel might not have the knowledge or experience to manage credentialing. It might also require more input from the providers, which takes time away from patient care.

Outsourcing can be a cost-effective and efficient solution if the provider does not have enough resources, staff, or expertise to manage the credentialing process effectively.

2. Lack of expertise delaying credentialing process

Credentialing can be complex and time-consuming, requiring specific knowledge and expertise. If the provider organization lacks in-house expertise, the credentialing process becomes incredibly long and tedious, consisting of back-and-forth correspondence. Outsourcing to a specialized vendor can ensure accurate and timely credentialing.

3. Regulatory compliance changes

Daily tasks may demand more time than administrative personnel can manage, leading to a lack of focus on other tasks requiring proactive actions. Credentialing requirements can vary by state, region, or even by the payer. Providers must stay up to date with changing regulations to ensure compliance, and this task requires time.

Outsourcing to a vendor specializing in credentialing can help providers comply with changing regulations. Vendors like Neolytix have specific individuals within their teams whose responsibilities include playing regulatory watchdog and feeding new information to the rest of the group so everyone remains well informed.

4. Scalability without compromising internal processes

As a provider organization grows, credentialing can become increasingly complex and time-consuming. Outsourcing to a vendor can help manage the increased workload without overburdening internal staff.

Also, if the burden becomes overbearing on the existing staff, it might lead to resignations or burnout. On the other hand, finding someone to replace practice administrative personnel or to find new employees to grow the team is very challenging in today’s economic environment.

5. Risk management

Apart from introducing another income source, credentialing is another critical stage for ensuring patient safety and quality of care. Although it happens very seldom, a single error in the credentialing process can lead to severe consequences.

Companies like Neolytix have dedicated teams who specialize in credentialing. Outsourcing to such a vendor will improve turnover time, reduce the risk of errors, and improve patient safety.

How Neolytix can help improve credentialing for your practice

If you have been in medical practice for years, you already know that enrollment and credentialing are time-consuming. It is complex and full of a wide range of potential setbacks. At Neolytix, our full-service credentialing solutions can take on the strenuous workload on your behalf, making the process streamlined, efficient, and rewarding for your organization.

outsourcing credentialing

The range of services we offer also includes but is not limited to:

  • CAQH registration and attestation,
  • Medicaid managed care organization credentialing,
  • Fee schedule negotiation,
  • NPI registration,
  • SUD/IOP credentialing
  • Medicaid credentialing
  • Medicare credentialing

If you are considering outsourcing provider credentialing services, please get in touch with us at Neolytix.

Call us today to discuss your organization’s unique enrollment and credentialing challenges and how we can help streamline the process.

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