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Common Provider Credentialing Errors

An ongoing problem for the healthcare sector is preventing medical errors that could endanger patient safety. Staff at urgent care facilities and hospitals are particularly under pressure to ensure that the care provided by their providers is of the highest calibre. Since proving a doctor made a mistake in treating a patient is the first step in a malpractice case, the focus will soon shift to figuring out whether improper credentialing played a role. There is little doubt that one of the best methods for healthcare companies to guarantee patient safety is through a professionally implemented provider credentialing Services.

Credentialing Data Collection and Verification Is Crucial

Credentialing experts are aware of the necessity to gather and authenticate as much pertinent data on applicants as feasible. However, despite having the most up-to-date technologies at their disposal and quick access to data, it’s still shockingly simple to ignore possible warning signs that could have serious ramifications in the future.

Credentialing specialists should stay away from these three common mistakes

Important information can – and often do – slip through the cracks, despite the most meticulous and diligent efforts to ensure that a supplier meets all the requirements. Here are a few of the most frequent explanations for why people frequently overlook this information.

1.      Working with a Provider’s Outdated Information

While the majority of the personal and professional details submitted by a candidate throughout the onboarding process aren’t particularly time-sensitive, some are. Specifically, information on prior disciplinary actions and/or malpractice claims can occasionally travel slowly via the different reporting entities.

If you don’t have the most recent information about the provider’s professional past, you risk missing really crucial warning indicators.

Credentialing Red Flags to Look Out For

The National Practitioner Data Bank (NPDB) exists to provide background information on providers, including suspensions lasting longer than 30 days, malpractice awards, loss of licensure or privileges, exclusions from health plans, and criminal/civil judgments, but it doesn’t always provide the complete picture.

For instance, a prospective provider might have spent years the focus of an internal conduct investigation by a prior employer, only for the investigation to be wrap up and not disclosed after the provider’s leave. Furthermore, even if it reported to the appropriate medical board or organization, it might not have been included in the NPDB due to the absence of any official disciplinary action.

The Kadlec Medical Center v. Lakeview Anesthesia Associates case is a prime illustration of a negligent credentialing claim (2006). After filing a malpractice lawsuit against Lakeview Anesthetic and Kadlec Medical Center, a patient who had sustained significant brain injury after surgery obtained a $7.5 million settlement. After the settlement was reached, Kadlec sued Lakeview Anesthesia Associates, alleging that they had given false reference letters regarding the concerned anesthesiologist, Dr. Robert Berry.


Both Lakeview Regional and Lakeview Anesthesia were accused of failing to disclose Dr. Berry’s history of carelessness and drug use in the lawsuit. The central claim in the case was that, in Kadlec’s opinion, Lakeview knew or ought to have known that the practitioner posed a risk to both parties.

Although a jury found in Kadlec’s favour and against both claimants, the verdict was later appealed to a higher court. Although the case against Lakeview Regional Medical Center was ultimately dismissed for procedural reasons, it unmistakably demonstrated that hospitals may be held liable for neglecting to disclose the actions of former members of their medical staff.

2.      Information for Primary Source Verification is missing

Teams responsible for verifying credentials rely on primary source techniques to check the veracity of submitted provider data. However, some information may be challenging to confirm for a number of reasons, leaving the door open to the inability to authenticate crucial data.

For instance, a doctor might have completed an unapproved residency or fellowship programmes but omit to list the names and contact information of those who can verify the claim on the credentialing application. Under time constraints, the specialist may use less-than-ideal secondary verification methods that cause delays and may not always be as reliable in order to complete the credentialing and approve the application.

The applicant must give the most current and precise contact information required to check their background. The application regarded as incomplete unless this crucial information is submit.

3.      Data Entry Errors

Data input is use to enter much of the provider information that is utilized to inform decisions about provider enrollment and credentialing. Unfortunately, data entry mistakes happen frequently, and a simple carelessness with details might compromise the accuracy of the entire provider credentialing services.

Credentialing solutions like Cactus and the nonprofit Council for Affordable Quality Healthcare (CAQH) Proview (formerly Universal Provider Data Source) are highly effective at reducing data entry errors, ensuring that your provider network data is error-free. This is because standards for collecting healthcare provider data established.

Avoid These Common Credentialing Problems

Despite their apparent simplicity, these frequent mistakes can have detrimental effects on patient safety and organizational liability. Adopting best practices and healthcare data management platforms will assist assure successful outcomes, whether you are credentialing a provider application or carrying out a provider enrollment procedure to ensure prompt reimbursement from insurance carriers.

With cutting-edge solutions, services, and support, Simpler covers all the bases, including credentialing, enrollment, and privileging of providers, measuring provider and practice quality, and managing vendor and visitor activities in your facility.

Before Selecting Provider Credentialing Software Need to look 4 Things

Online resources abound with tips on how to compare software vendor quotes. And if it seems that certain businesses encourage customers to choose a supplier credentialing software platform quickly, you are not alone. However, due diligence is essential because provider data management cannot be standardize. Regardless of whether you have previously gone through the vetting process, we provide advice you might not have considered.

The durability of a software choice

Do you regret signing a contract for credentialing or payer/provider enrollment (PE) software after discovering it is unable to meet your needs? Making a mistake now can have a long-term detrimental impact on your organization’s income, careers, and productivity.

Based on survey responses from more than 500 provider management organizations nationally, take a look at the data below to see how long and how frequently you should prepare to be dependent on your software choice:

  • 55% have used the same software program for six or more years
  • Two-thirds use their credentialing software for more than 50% of their day

1.      Value and Price

Price is a key factor because ultimately, the budget is what matters most. However, take caution if one quote during the bidding process is much less than the others. Value and price are not the same. To earn your business, a reputable software seller will make a little price concession. However, your red flag (the same one you use during credentialing) should go up if you come across a solution that costs thousands of dollars less. There is no secret that enables new and alternative software providers to provide comparable products and services for a far lesser cost than competitors. The assistance or offering simply won’t be as strong or sophisticated. Otherwise, in order to compete, all vendors will unilaterally lower their prices. It’s true that you get what you pay for.

2.      Functionality and usability

Exciting, new, and flashy. Dashboard elements display beautifully in demos. Two to six months after integration, go forth and forward. Around that time, you should have had experience with the majority of the functions and reports. Why is the user interface so vibrant?

When all you have is a few demos to base your judgment on, functionality may be the most difficult aspect to evaluate. Remember that while an out-of-the-box model is typically demonstrate at first, further discussions must involve your users, IT support, representatives from the Quality, Enrollment, or Medical Staff departments, etc., as necessary. Don’t just rely on your sales rep when dealing with vendors. Talk to developers, operations, and implementation specialists within the vendor. Talk to users of each product to learn from their experiences, and finally.

3.      Scalability for lengthy strategies

It’s likely that you have access to your organization’s short-, medium-, and long-term goals in relation to the provider data that the solution will keep if you’re evaluating and choosing software. Ask and, to the degree possible, share the objectives with the vendor if you are unsure of what they are. It’s not a good fit if the prospective software company’s sales or support staff can’t demonstrate how the solution can be scaled or modified to satisfy each of those goals now and in the future via the existing or planned future versions.
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