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Simplifying provider credentialing with primary source verification APIs

Credentialing is a critical process in the healthcare industry as it ensures that healthcare providers possess the necessary qualifications, skills and experience to deliver quality care.

When done manually, it’s a very labor-intensive and time-consuming process can lead to inefficiencies and increased costs for healthcare organizations. Reports show that delays in getting clinicians credentialed can cost provider groups about $10,000 per day.

At its core, credentialing is the verification of certain credentials providers may claim that they may have, like the medical school they graduated from, certain licenses they hold and more. 

This critical process is known as primary source verification (PSV) and it's the job of the healthcare organization or an outsourced certified credentialing organization (CVO) to make sure those provider claims are all true.

Or if there are issues or irregularities, they point them out so that someone can make a decision based on that information. 

Healthcare organizations or CVOs are required to primary source verify their providers. This step is mandated by accrediting agencies such as the Joint Commission, HFAP or the DNV to ensure the accuracy and reliability of a provider’s information and data, to protect patients and help healthcare organizations deliver and maintain high standards of patient care.

Challenges in traditional credentialing processes

Traditional credentialing processes involve tedious, manual tasks, however.

Collecting, verifying, and maintaining healthcare providers' credentials requires significant time and effort and when this process is performed manually, several issues can arise throughout the entire credentialing process which impacts everyone involved — from providers to health plans and organizations and patients. 

Lengthy timelines are a standout issue. It’s common and standard practice to conduct verifications at the time of hire and at time of a provider’s license renewal. 

Traditionally, verifications are performed via a manual license look-up process. While many state boards and other primary sources have electronic databases with the license/certification/registration information accessible via a secure website, there are several others that haven’t yet migrated to a digital infrastructure. In such cases, verification is possible by way of phone, fax or written mailed correspondences. 

As a result, most primary source verification processes can take anywhere from 90 to 120 days to complete which leads to higher  administrative burdens and operational costs for healthcare organizations.

Manual processes can also lead to process inconsistencies and inefficiencies. Misinterpretation of information, data entry errors and missed deadlines can all lead to incorrect credentialing decisions and expose healthcare organizations to legal and regulatory compliance risks.

Additionally, another key consequence of traditional credentialing processes is the delayed onboarding of healthcare providers.

Lengthy and cumbersome credentialing processes  can result in significant delays in hiring and deploying qualified healthcare professionals.

And, when medical practices spend, on average, $7,000 for each provider credential application, plus another 20 hours of administrative time, this puts a significant strain on understaffed facilities, increasing workloads for staff and providers and decreased patient satisfaction due to longer wait times.

The role of primary source verification APIs

Primary source verification (PSV) APIs play a critical role in simplifying the credentialing process. By automating the verification process, these APIs reduce the time and effort required for manual data collection and validation. This step leads to greater efficiency and allows healthcare organizations to focus on delivering high-quality patient care, instead of being bogged down by administrative tasks.

Implementing primary source verification APIs can significantly reduce the potential for human errors in the credentialing process. Digital solutions like Medallion’s PSV API provide an accurate and consistent method for verifying healthcare providers' credentials, eliminating the risk of misinterpretation or data entry errors. This ensures that healthcare organizations maintain accurate and up-to-date credentialing information, improving patient safety and reducing the risk of legal and regulatory issues.

By streamlining the verification process, primary source verification APIs enable faster onboarding of healthcare providers. Healthcare organizations can quickly verify credentials and make informed decisions about hiring and deployment, reducing delays and ensuring that patients receive timely access to qualified healthcare professionals. This not only enhances patient satisfaction but also helps healthcare organizations maintain optimal staffing levels and deliver high-quality care.

Benefits of Medallion's PSV API

Medallion's PSV API provides a streamlined credentialing process for healthcare organizations byeliminating  time-consuming manual tasks and simplifies the overall credentialing workflow by automating the verification and validation of healthcare providers' credentials. 

One of the key benefits of using Medallion's PSV API is the improved accuracy and reliability of credentialing data. By verifying credentials directly from hundreds of primary sources, Medallion pulls in the information to ensure that healthcare organizations have access to the most accurate and up-to-date information and, ultimately, a single source of truth. 

Additionally, Medallion's PSV API prioritizes security and compliance, ensuring that healthcare organizations can trust the integrity of the credentialing data they rely on. By adhering to industry standards and utilizing secure data storage and transmission methods, the platform helps healthcare organizations maintain compliance with relevant regulations, pass NCQA audits and protect sensitive credentialing information.

Medallion's PSV API enables healthcare organizations to credential more providers in less time, delivering significant cost and time savings. The platform reduces the need for manual data collection and validation, resulting in lower administrative burdens and operational costs. Additionally, faster onboarding of healthcare providers leads to improved efficiency, better patient care and overall cost savings for the organization.

Integrating Medallion's PSV API into your healthcare organization

Medallion's PSV API is designed to be easily integrated into your healthcare organization's existing systems and processes, ensuring minimal disruption to your operations.

Compatibility with current infrastructure minimizes the need for costly system upgrades or replacements and our integrations extend beyond just about what a platform can do, but also how well they play with the other tools in your ecosystem.

Medallion offers native integration with Salesforce, for example.

For healthcare organizations using the Salesforce CRM, Medallion’s robust integration with Salesforce is designed to automate credentialing and primary source verifications within the Salesforce platform.

When a provider is added or updated in Salesforce, the system automatically sends a call to Medallion’s API to create or update the same provider within the Medallion platform.

This workflow ensures your data is consistent across platforms, helping you avoid manual data entry and the potential errors that come with it.

And this level of automation and synchronicity is just a small part of Medallion's ongoing commitment to deliver a comprehensive, cohesive provider network data management experience, supporting streamlined workflows and efficient processes for your team.

When integrating Medallion's PSV APIs into your healthcare organization, you can rely on dedicated support from our side, including assistance with implementation, ongoing technical support and access to a wealth of knowledge and expertise.

Simplify provider credentialing with Medallion’s PSV API

Primary source verification APIs present a transformative solution for healthcare organizations. Backed by data and powered by Medallion's cutting-edge technology, Medallion’s API elevates the credentialing process, enabling greater efficiency, accuracy and security.

Experience the benefits firsthand by partnering with Medallion to transform your organization's credentialing process and unlock the full potential of streamlined, automated and accurate primary source verification for unparalleled patient care.