ACA Blog

Anthony Centore
Jul 14, 2011

5 Reasons why Medical Credentialing Software is Useless for Most Health Practices

Medical credentialing (the process of getting on insurance panels) is a hassle for many health providers. In response to this, several credentialing software companies have popped-up over the last few years, promising that their software will make the credentialing process easier. But will it?

In this article, we will look at how medical credentialing software works, and review several reasons why—unless your company has over 100 health providers—credentialing software won’t save you time, or make the credentialing process easier.

Full disclosure: I am the owner of a medical practice with a dozen mental health professionals. I began looking into medical credentialing software several years ago, and have spoken with several of the major companies as late as a summer 2011. In addition to running a small medical practice, I also consult frequently with other medical practices (often counseling practices). Thirdly, and possibly most relevant for the reader concerned about author bias, I also run a company that provides medical credentialing services to health professionals (at http://medicalcredentialing.org). After much investigation, even though we are credentialing around 100 health professionals at any given time, we have determined that credentialing software cannot make our service more efficient for our employees, or our customers.

Now, let’s look at why medical credentialing software is a time waster, not a time saver.

1) Medical Credentialing Software Requires Hours-to-Days of Training
In general, the way credentialing software works is as follows: Paper-based provider enrollment applications are scanned into the software system, and “Mapped.” Mapping, in essence, means to take a paper-based application and turn it into an electronic form, where provider information can be typed (or imported) onto the application.
While the concept is straight forward, the execution is complicated. Training on how to use the software is laborious. One of the largest medical credentialing companies requests that new customers send their administrative staff for a weekend-long training course.
Hence, learning to use the software takes more time than most health practices will ever spend filling out provider applications manually. This, already, makes medical credentialing software unhelpful. However, in addition…
2) Using The Software Doesn’t Save Time
Even after someone is trained on how to use credentialing software, using the software still will not save time for practices with under 100 providers. If a medical practice has 100 providers or more, and each needs to be added to a specific group (let’s say 10) of insurance panels, medical credentialing software could save some time. Instead of needing to fill out 10 applications for each provider (one for each insurance company), one application can be completed for each provider, and that information imported electronically onto the other 9 applications, thereby saving transcription time.
The problem for the practice with less than 100 providers is that mapping a single new insurance application into the system can take several hours, and even then it might not work 100% correctly—and will need additional tweaking. Because of this, all the timesaving benefits are spent setting up the software.
This brings us to the next problem…
3) The Software Programs don’t have all the Applications you Need
Medical Credentialing Software companies claim that they have hundreds or thousands of provider applications in their systems, representing insurance companies across the USA. This may be true, but even the largest medical credentialing companies—when you really get down to brass tasks with them—admit they usually have less than half of the forms that any given customer needs (if you are working in behavioral health, for instance, forgettaboutit. There is a dearth of behavioral health applications in these systems).
Even is the software appears to have the application you require, beware! Health insurance companies are often updating their provider application forms—sometimes as frequently as every 6 months—and credentialing software has no feature for tracking or keeping up with this. Hence, submit an application generated from medical credentialing software and you might find that the application is rejected because it isn’t the most up-to-date form.
In addition…
4) Medical Credentialing Software is Useless for Online Applications
Many insurance companies are switching from paper-based documents to (exclusively) online provider application forms. This renders medical credentialing software useless, as there are no paper applications to map. And finally…
5) Completing the Provider Application is Just the Beginning.
Medical credentialing software companies claim that they save health organizations time by helping those organizations get health providers’ information down on paper faster.
While, for the reasons stated above, I don’t think this is true for any practice under 100 providers, even for larger organizations the reasons medical credentialing is time-consuming have little to do with filling out provider applications.

Instead…
The Essence of Medical Credentialing
Getting on insurance panels is a grueling process because (1) convincing insurance companies to accept your application can be a challenge, as many good panels are stating that they are ‘closed’, (2) provider applications are always changing, and every application is different, (3) credentialing requires a plethora of accompanying documentation, which needs to be provided exactly as requested, (4) credentialing applications are often lost by insurance companies, or get stuck in the review proves, and (5) successfully getting on insurance panels requires frequent calls to insurance companies to check-up on applications, and to help push the applications through to completion.

When it comes to these tasks, medical credentialing software is dead in the water.



Anthony Centore is a counselor, and helps other counselors build successful practices. For more information on private practice and insurance panels go to http://thriveworks.com .

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