Streamlining the Insurance Credentialing Process: A New Approach to a (Not-So) Old Problem

The insurance industry is replete with acronyms, processes, and procedures. In fact, the majority of insurance professionals are quick to point out that much of what we do is “procedure heavy” rather than a more innovative industry. That’s why it shouldn’t be surprising that when it comes to our credentialing process for new practices, we are still stuck in the 1990s. It remains an arduous process with redundant documentation requirements. Additionally, even though technology has advanced exponentially over the past two decades, we require everyone to fax documents back and forth between offices as well as scan them individually into an online repository so they can be found when needed later on. To make matters worse, because these same documents must be updated every time a policyholder name changes or an provider moves to another office or state, there’s also no master document which would easily allow for a new address or other updates to be completed once and then automatically populate in all other instances across the organization. As you can probably imagine — this isn’t just time intensive; but it also results in numerous spelling errors and inconsistencies across policies

“Procedure heavy” rather than a more innovative industry

The insurance industry is replete with acronyms, processes, and procedures. In fact, the majority of insurance professionals are quick to point out that much of what we do is “procedure heavy” rather than a more innovative industry. This is why it shouldn’t be surprising that when it comes to our credentialing process for new practices, we are still stuck in the 1990s.

It remains an arduous process with redundant documentation requirements. Additionally, even though technology has advanced exponentially over the past two decades, we require everyone to fax documents back and forth between offices as well as scan them individually into an online repository so they can be found when needed later on.

Redundant documentation requirements

An example of redundant documentation requirements is the COI (Corporate Officers Identification) which is typically required of a board of director member’s names along with their titles. Many companies will request that the COI also include their SSN.

Another example is the State Identification Number (SID) where one company will want the SID be entered into their system as the address and another company will want the address and SID entered as the address. Another company will want the address and SID entered as both the address and SSN. All of these variations not only create redundancy in the system, but once again increase the likelihood of human error.

Our credentialing process

Our team of experts works closely with providers to determine which insurance companies and networks you wish to join. Examples of these carriers include Medicare, Medicaid, commercial carriers, and workers’ compensation carriers. During the credentialing process, our credentialing expert completes your applications and monitors their status until they are entered into the carrier’s system. Additionally, your credentialing specialist will gather price schedules from contracted carriers.