Hiring competent healthcare providers and familiarizing them with the system is a daunting step for healthcare practices. A few decades back, credentialing and onboarding ways were introduced to mitigate the risk of hiring less skilled professionals. These two procedures are core principles that verify healthcare practitioners meet all the requirements which are set by healthcare organizations.
Obligatory educational qualifications, training certificates, work experience proofs, and licenses are considered basic requirements for undergoing credentialing and onboarding. These processes benefit healthcare organizations by establishing a provider-friendly environment, which helps to enhance efficiency. By using a smooth and well-structured provider onboarding and credentialing process, healthcare organizations can minimize the uncertainties and instabilities in patient care delivery.
In this article, we will discuss the basic concept of provider onboarding and credentialing and their checklist. We will also explore the importance of these processes and key steps concerned with checklists.
Understanding Provider Onboarding and Credentialing
What Is Provider Credentialing?
Credentialing is a process of verifying qualifications, experience letters, licenses, diplomas, certifications, criminal backgrounds, and work histories of healthcare providers. Credentialing is a monitoring process that ensures providers meet all necessary protocols for effective patient care introduced by HIPAA. The professional standards of healthcare practitioners are being checked in this process to determine whether they are eligible for this job or not.
Credentialing helps healthcare organizations appoint highly qualified, competent, and trustworthy healthcare practitioners to maintain high standards of care for patients. The timing of credentialing varies from healthcare department to department. It can take several weeks to months
What Is Provider Onboarding?
Provider onboarding is a procedure in which a healthcare organization welcomes the healthcare specialist and makes him familiar with the rules and regulations of the healthcare department. Healthcare organizations arrange free seminars, training sessions, and meetings with healthcare workers to make them aware of the policies and norms of their departments.
This is the initial step of accepting newly appointed healthcare providers into the healthcare organizations and educating them about the environment, culture, and conditions of the healthcare departments. The elements of onboarding are providing access to electronic health records (EHRs), training workers about the policies of organizations, and allocating facilitators for continuous assistance.
Provider Onboarding And Credentialing Checklist
Provider onboarding and credentialing is a step-by-step process. There exists a comprehensive provider onboarding and credentialing checklist and guide for the successful operation of provider onboarding and credentialing. Following all protocols validates that all steps of these procedures are accomplished in an accurate manner. Below are some phases involved:
1. Pre-Onboarding Phase:
This is the phase that takes place prior to the appointment of the healthcare practitioners. It includes understanding department credentialing rules and regulations, gathering necessary documents, and establishing good communication with employers. Below is the checklist for the credentialing process:
- Copies of medical licenses
- DEA (Drug Enforcement Administration) registration
- Board certifications and diplomas
- CV/resume with detailed work history
- Proof of malpractice insurance
- NPI (National Provider Identifier) number
- Tax identification number (TIN)
If we talk about the checklist for provider onboarding, then access to electronic health records is necessary to enable providers to understand how things work in patient care. The introductory brochure is also handed over to the newly appointed healthcare workers, in which all rules and regulations of the healthcare organization are written, and workers are directed to follow them. This stage is also known as the preparatory phase.
2. Credentialing Phase:
This phase is a very crucial phase in which in-depth verification of the credentials of healthcare providers is done. Certifications, boarding licenses, and work histories are reviewed by the healthcare department. This step confirms that healthcare professionals meet all requirements and professional standards that are set by healthcare organizations and are eligible for the job. This step can take several weeks to months, depending upon the efficiency of the healthcare department.
3. Post-Onboarding Phase:
This is the last step of the comprehensive checklist, which takes place after the selection of the healthcare professionals. This step emphasizes the orientation and training of these newly selected workers. The purpose of this phase is to make them familiar with the culture, environment, and norms of the organization. In this phase, concerns and queries of new healthcare providers are answered, and regular meetings are arranged with them.
Best Practices for Provider Onboarding and Credentialing
Provider onboarding and credentialing operations can be made more optimized and sleek by adopting some practices such as mentioned below:
- Start Early: Healthcare organizations should initiate onboarding and credentialing when professionals show consent to the agreement. This strategy minimizes delays and offers a streamlined procedure.
- Use Technology: The use of modern technology, such as credentialing software, can make this operation more successful and reliable. This software has the ability to automate data collection, track progress, and improve communication. The use of technology saves time and also eradicates the chances of human errors.
- Establish an Expert Team: In every healthcare Organization, there should be a proficient and designated team who in charges these processes. This will lead to a quick and transparent operation of credentialing.
- Standardize Processes: There should be implementation of efficient and standardized policies in every healthcare department. This measure leads to the same protocols and parameters to be followed by providers while working in different practices.
- Communicate Clearly: Organizations should hold a meeting with the newly appointed healthcare workers and discuss all the queries and concerns in a straightforward way.
Importance of Provider Onboarding And Credentialing
Provider onboarding and credentialing have emerged as saviors in the medical field to ensure patient safety, financial growth, and less claim denial rate. Some key benefits of these operations are mentioned below:
- Ensures Patient Safety: Thorough and detailed verification allows only highly qualified healthcare workers to deliver care to the patients. These processes mitigate the chances of uncertainties and risks in hospital practice.
- Reduces Compliance Risks: To fulfill all legal, professional, and organizational standards, it is necessary to hire professionals only. This can only be possible by applying error-free credentialing and onboarding processes. The appointment of highly proficient and certified professionals directly reduces all compliance risks.
- Patient Satisfaction: A transparent and efficient credentialing process creates a sense of satisfaction and safety among patients. With the help of these processes, organizations select healthcare professionals on the basis of merit, only making the healthcare industry more trustworthy.
Conclusion
Provider onboarding and credentialing are processes to streamline hiring new providers and make them familiar with practice rules and regulations. With the help of these operations, the credentials of healthcare professionals are checked for legitimacy. In-depth verification allows only proficient and competent healthcare practitioners to deliver patient care. By adopting comprehensive checklists and guides, these procedures can be made more streamlined and refined.
There are three phases involved, including pre-onboarding, credentialing, and post-onboarding phases elaborating provider onboarding and credentialing checklists. Patient safety, compliance, and optimized revenue cycle are ensured by adopting these methods while hiring new providers.
FAQ - People Also Asks
Provider credentialing typically takes 60-120 days. Several factors, including time for primary source verification, efficiency of organization, and complexity of provider’s credentials, affect the processing time.
It is very important to measure the success score for the onboarding process. Success can be estimated by measuring certain metrics like time to productivity, satisfaction level of providers, and number of accurate credentialing files.