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Get Day 1 Revenue with efficient provider credentialing practices

As a healthcare provider, you know that the process of credentialing with payers can be a long and tedious one. 

It often involves submitting multiple forms, waiting for approvals, and dealing with delays that can significantly impact your revenue.

But it doesn't have to be this way. 

See how this behavioral health group transformed its growth strategy by streamlining legacy credentialing and generating, what we call, Day 1 Revenue.

Finding a way to unlock your Day 1 Revenue can help you overcome several obstacles across credentialing and lead to happier, retained providers, stronger cash flow, cost savings and scalability.

Why is provider credentialing important?

Provider credentialing is the process of verifying a healthcare provider's qualifications, experience, and background to ensure they meet the standards set by insurance companies. This process is necessary for providers to be able to bill and receive payment from insurance companies for services rendered.

Ensures quality care for patients

One of the main reasons why provider credentialing is important is that it ensures quality care for patients. By verifying a provider's qualifications and experience, health plans can be confident that the provider is capable of delivering high-quality care to their members.

Protects against fraud and abuse

Another crucial aspect of provider credentialing is that it helps protect against fraud and abuse in the healthcare system. By thoroughly vetting providers, health plans can prevent unqualified or fraudulent providers from billing for services they did not provide — and protect their organization from fines due to compliance risk.

Required by health plans

Health plans require providers to go through the credentialing process before they can be added to their network. This means that if you want to be able to bill and receive payment from these companies, you must go through the credentialing process.

The impact of inefficient provider credentialing

Inefficient provider credentialing processes can have a significant impact on your revenue and overall business operations. Here are some of the ways that inefficient credentialing can affect your practice:

Delayed revenue

The most obvious impact of inefficient provider credentialing is delayed revenue

When providers are not credentialed in a timely manner, they may not be able to bill insurance companies for services rendered, resulting in delayed payments and a negative impact on cash flow.

The cost of delayed revenue can vary depending on the size and specialty of the practice. Take for example, that on average, a one-day delay in provider onboarding can cost a medical group $10,122 — and that’s per provider. 

It’s easy to see that delays from onboarding can lead to delays in getting a provider credentialed and that can have a significant impact leading to financial strain, increased administrative burden, and missed opportunities for the practice.

To mitigate the cost of delayed revenue, it is crucial for healthcare providers to prioritize efficient provider credentialing processes. 

By starting the credentialing process early, using the right technology to power your workflows, and considering outsourcing credentialing services, providers can minimize delays and ensure timely reimbursement for their services.

Increased administrative burden

Inefficient credentialing processes can also lead to an increased administrative burden for your practice. This can include filling out multiple forms, submitting paperwork, and following up with insurance companies, all of which can take up valuable time and resources.

Missed opportunities

In some cases, inefficient credentialing processes can result in missed opportunities for your practice. For example, if you are unable to bill insurance companies for services rendered, you may lose patients who are looking for providers that are in-network with their insurance plans.

What is Day 1 Revenue and how to use it overcome inefficient credentialing challenges

Now that we understand the importance of efficient provider credentialing and the impact of inefficient processes, let's discuss a key strategy for overcoming delayed revenue caused by these processes. 

Day 1 Revenue is the practice of fully credentialing providers by the first day of their job to avoid revenue delays and write-offs. And it involves a few critical steps to achieve it. We’ll look at some of them below. 

Redefine your provider hiring process

Develop a clear and concise job description to attract suitable candidates. When recruiting providers, it's important to clearly outline the qualifications, experience, and skills required for the position. This will help attract candidates who meet the necessary criteria and reduce the time spent reviewing applications from unqualified individuals.

Start the credentialing process early

One of the best ways to avoid delayed revenue is to start the credentialing process as early as possible. This means submitting your application and all required documents well in advance of your desired start date with an insurance company. It means integrating credentialing steps into the hiring workflow. This can include collecting required documents and information from candidates during the application or interview process, so that you can initiate the credentialing process as soon as the offer is accepted.

Use a credentialing checklist

A credentialing checklist can be a valuable tool for ensuring that you have all the necessary documents and information before submitting your application. This can help prevent delays caused by missing or incomplete information.

Utilize technology

Technology can be a game-changer when it comes to efficient provider credentialing. There are many software solutions available that can streamline the credentialing process, making it faster and more efficient. 

From the start, utilize automation for efficient provider background checks. Consider using digital platforms or software solutions that offer real-time tracking of background check status. 

This can help you stay organized and ensure that all necessary checks are completed in a timely manner. Medallion uses a Checkr integration to help you track the status of provider background checks in real-time. 

Outsource credentialing services

If you don't have the time or resources to handle credentialing in-house, consider outsourcing this task to an NCQA-certified third-party CVO. Medallion specializes in provider credentialing and can help you navigate the process more efficiently.

Start unlocking Day 1 Revenue now

Efficient provider credentialing is crucial for unlocking your Day 1 Revenue and ensuring the success of your practice. By starting the credentialing process early, utilizing technology, and outsourcing credentialing services, you can overcome delayed revenue caused by inefficient processes and focus on providing quality care to your patients. Remember to stay organized and use a credentialing checklist to ensure a smooth and efficient credentialing process. Get more details on Medallion’s credentialing products