Availity Blog

It's Time to Fix the Credentialing Process


10.12.2017 By Michelle Barry, Expert, Health Plan Provider Data Management


Availity recently commissioned an independent research company to survey providers—physicians and non-medical staff, in practices and facilities—about their credentialing process. No one should be surprised that providers are not happy with how it’s conducted.

In fact, just 20 percent of respondents say they are “Satisfied” or “Very Satisfied” with the way states and health plans credential practitioners.

Providers’ biggest complaints about the credentialing process include:
  • Sheer volume of paperwork required (80%)
    Assembling, tracking, and submitting the variety of forms and documents required is the most-often cited problem with today’s credentialing process. Nearly three in four providers (70 percent) store the information on computers, flash drives, or personal cloud storage—which credentialing staff may not have access to.
  • Complexity and variety in the information required (79%)
    The typical practice works with 17 health plans (facilities average more than 20) and almost every plan has different credentialing requirements and proprietary forms. The administrators, credentialing managers, or credentialing specialists fulfilling these requirements must often complete paper forms by hand. Add state and CMS requirements into the mix, and onboarding a single practitioner becomes very difficult, very quickly.
  • The time it takes
    We heard that the average time to pull together all the information needed for initial credentialing is about eight hours, plus additional time for non-standard requests for some health plans and states. Once the package is complete, 38 percent of respondents report average wait times of more than 31 days before they receive a decision. Some say they’ve waited up to a year—at which time the application is no longer valid, and must be started over.

No one disputes the need for credentialing: patients, practices, and plans need to know that those delivering care are qualified to do so. But as value-based care and risk adjustment become the norm instead of the exception, verifying and updating provider credentials must be streamlined. When administrative processes are simplified, providers and health plans can focus on better outcomes—instead of paperwork.


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