6 Tips for Outsourcing Your Credentialing Services

Charlotte Miller

Updated on:

Credentialing can help healthcare facilities make sure they are capable of offering quality and compliant services. Actions like setting clear objectives and developing a transition plan can help facilities considering outsourcing their credentialing activities. Here are six tips for healthcare practices interested in outsourcing credentialing services:

1. Set Clear Objectives

You can start by defining your healthcare organization’s targets, such as lowering the administrative workload and enhancing regulatory compliance. Defining the timelines of different targets can make your credentialing needs clearer. Setting clear objectives may help you assess the capability of a credentialing services provider to meet your healthcare facility’s requirements. The objectives can help you determine if the credentialing service specializes in medical credentialing and uses relevant software that can help you achieve your goals.

2. Choose a Credentialing Partner

Research credentialing providers and their services online to make sure the outsourcing provider can meet your facility’s needs. Look into the company’s values, such as their trustworthiness and customer service quality. You can also check whether the credentialing provider offers solutions like automated tracking of billing services and contract negotiations with insurance companies.

3. Make a Transition Plan

Businesses can create a transition plan before initiating credentialing services. A transition plan is a structured approach for smoothly transferring responsibilities from an in-house credentialing process to an external service provider. This plan is designed to provide a step-by-step overview of the entire course of events, from contract negotiation with the credentialing service provider to the secure transfer of patient records. It may define the updated credentialing obligations of your staff, if applicable, and outline the professional service provider’s responsibilities. Consider working with your credentialing partner to determine the course of events and set achievable expectations that you find convenient.

4. Train Your Staff

Equip your staff with skills that enable them to work with the outsourcing partner efficiently, as this may help streamline the transition process. Consider implementing training modules to help your staff learn to use any software or tools provided by the third-party services. You can establish open communication lines enabling staff feedback, allowing employees to submit reports regarding challenges they face when using credentialing software for managing healthcare provider records. This may help your staff adapt to the outsourced credentialing services, enabling them to master the new processes and workflows.

5. Conduct Frequent Evaluations

Frequently evaluate your credentialing partner’s performance of services like medical billing and verification of healthcare service provider qualifications. You may define key performance indicators (KPIs) such as the time of processing applications and the percentage of enrollment denials. Regularly reviewing and assessing the effectiveness of the outsourced credentialing services can help identify opportunities for continuous improvement, such as reducing the rate of denied claims.

6. Outsource Credentialing to a Single Provider

Your facility’s credentialing processes may be quicker when the professional partner you choose offers various credentialing services. Some services that experienced credentialing service providers may offer include payer contract negotiation services, medical practice start-up services, electronic health record (EHR) services, website and marketing services, and billing services. Having one credentialing partner with the necessary in-house expertise can help you avoid lengthy back-and-forth correspondence. The resulting timely services can lead to enhanced patient satisfaction in your healthcare facility.

Outsource Your Credentialing Services

Outsourcing credentialing services may offer benefits such as lower administrative burdens, efficient billing, and lower rates of medical claim denials. Skilled credentialing service providers can also verify that your services comply with practitioner license regulations and patient information confidentiality. Defining your objectives, selecting a suitable partner, establishing a transition plan, and training your staff can lead to effective credentialing. Contact an experienced credentialing service provider today for quality healthcare services compliant with federal and state standards.