Credentialing, the process of verifying a specific healthcare professional's qualifications, training, educational background, skill set, and experience before allowing them into a network, traditionally used to be a time-consuming and paper-heavy process.

But now, with technological progression, providers and health systems can save their valuable time, money, and legwork by automating the credentialing process.

In this article, we will explore the need for credentialing, a comparison between manual and automatic credentialing systems, and how automation can solve countless credentialing issues and streamline the onboarding process.

Why can’t we just analyze candidates looking to enter the healthcare field based on what’s on paper and bring in all the help this industry needs?

In simplest terms, the results could be devastating because an error can go beyond financial loss and threaten human life.

There are several reasons why credentialing is an absolute need for the growing healthcare industry:

Credentialing helps you verify if the said person is fit for the job. By verifying their education, qualifications, and experience, unqualified individuals are prevented from practicing and potentially harming patients.

Credentialing establishes professional quality standards that enable healthcare organizations to provide high-quality care consistently and protect patients from getting subpar treatment.

Credentialing decreases the probability of a financial and legal risk for healthcare providers and health plans since there are fewer chances for malpractice suits and legal repercussions.

Knowing their provider is qualified and carefully vetted enables patients to trust and have confidence in the treatment provided. This also ensures that there is an ongoing concept of accountability—healthcare professionals operate in the best faith, with compliance to Standard Operating Procedures (SOPs) and vigilance, so that they don’t lose their license.

Credentialing has always been around—ever since ancient times. Around 1000 B.C., Persians developed a process for physicians to earn a licensure before practicing publicly.

Documented proof of credentialing dates back to the 13th century. In the US, CAQH’s (The Council for Affordable Quality Healthcare) credentialing has been an industry standard for more than a decade and is currently used by over 2 million providers and nearly 1,000 participating organizations.

However, credentialing has always been a highly manual process until recently. During a survey by the Medical Group Management Association (MGMA), at least 73% of provider executives said their organizations are focusing on automating physicians’ administrative tasks.

But why was there an urgent need for this change?

The MGMA survey highlighted that over half of medical practices reported an increase in denials related to provider credentialing in 2021. This eventually caused the industry to shift toward automated credentialing systems.

The credentialing requirements must stay consistent for provider credentialing to be effective in maintaining a standardized, above-par quality of care across the healthcare industry.

Thus, it’s crucial as to who sets the credentialing requirements. Globally, this responsibility is shared by several key entities:

The NCQA provides guidelines for healthcare provider credentialing—their major focus is on technical aspects such as written policies, verification, ongoing monitoring, and data reporting.

Requirements for complementary health practitioners vary significantly across countries, and their local authorities set the requirements for credentialing systems. For example, the Medical Council of Canada (MCC) oversees it in Canada, the General Medical Council (GMC) manages it in the UK, and the Australian Health Practitioner Regulation Agency (AHPRA) is in charge in Australia.

The global COVID-19 pandemic revealed the limitations of manual credentialing, giving a wake-up call to make the onboarding process of healthcare professionals fast, smooth, and cost-effective—to cater to the rising need for professionals in healthcare facilities.

Moreover, a high increase was observed in the number of provider credentialing denials—not necessarily because of professionals lacking the skill, education, qualifications or experience, but because of the limitations, inaccuracies and inefficiencies of manual credentialing systems.

Let’s look at automated vs manual provider credentialing from a utilitarian point of view.

Verifying all of a provider's credentials manually is a very time-consuming process—with an extraordinary cost involved.

The verification process requires contacting multiple sources, such as schools, state licensing boards, and previous employers, to verify information provided by the professional.

Automated provider credentialing can save us from the staggering amount of legwork and smooths out the onboarding process by verifying provider credentials electronically—saving time, money, and exhaustion.

As the data involved in credentialing is stored in multiple locations, it is challenging to keep track of it all and ensure that every file or document is safe and secure. Since sensitive information is involved, manual credentialing is prone to security breaches and identity theft.

An automated provider credentialing system typically stores data in a secure, centralized location to protect it from breaches and unauthorized access.

There is a very high chance of error in manual data entry, and it can be difficult to keep track of that margin of error when dealing with extraordinarily large amounts of data. That’s exactly why manual provider credentialing is highly prone to delays and inaccuracies in the credentialing process—which results in an increased number of denials.

Automating the process eliminates all potential mistakes that could happen during manual data entry and verification, ensuring accurate capture and validation of provider credentials from reliable sources. Moreover, automation allows us to cross-reference across databases, scanning data from official websites and licensing boards—making the entire process error-proof. With such accuracy, automated credentialing systems can enhance patient trust and increase overall care quality.

Manual provider credentialing systems can be a mess—frustrating email threads, unanswered calls, and missed updates abound. As a result, there are communication gaps and delays, as information gets lost in the shuffle.

With an automated provider credentialing system, there is a more streamlined workflow—keeping everyone in the loop. There’s better communication as a result of automatic real-time updates, helping credentialing bodies monitor application progress, and identify any missing documentation in advance. This allows for timely intervention and resolution of issues—minimizing delays and inefficiency.

As manual provider credentialing relies heavily on paperwork, it’s a wasteful and environmentally unfriendly process. Moreover, manual files are hard to move and access which brings more delays and difficulties in the credentialing process.

Digital records save both your time and paper—making the entire process environmentally friendly. Also, easy accessibility from any location makes it easier to manage data.

In manual credentialing, tracking deadlines and renewal requirements is a very challenging ordeal since every record is manually maintained. In the case of an expiration, there could be a lot of complications—putting patients at risk.

Automated provider credentialing systems make it easy to set alerts and reminders for automatic monitoring of deadlines and renewal dates for various licenses, certificates, and other medical requirements. This ensures that all credentials are up-to-date and that there are no lapses in coverage.

Manual provider credentialing struggles to uphold compliance because it can be difficult to keep up with the latest credentialing regulations and requirements. As a result of non-compliance, there is a risk of fines and penalties.

Having automated credentialing systems can mitigate these risks and ensure ongoing compliance by offering streamlined verification, simplified workflows, automated alerts and reminders, improved data accuracy, and regulatory compliance tracking.