US Provider Credentialing-Industry Trends

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US Provider Credentialing-Industry Trends

INTRODUCTION

The short answer to the question is that there are four major trends in the U.S. Provider Credentialing Industry: Blockchain; Service as a Software (SaaS); CredSimple; and New Behavioral Healthcare Regulations. Each of these current trends is important for different reasons.

Below is a detailed account of my findings.

OVERVIEW

BLOCKCHAIN

Blockchain is a current trend in the U.S. Provider Credentialing Industry. Blockchain is a software offers a tamper-proof information sharing mechanism that lowers storage costs and incorporates accounting into the transaction records. Unfortunately, it is potentially in conflict with existing regulatory compliance approaches, and potential health care providers lack a clear vision for how to use it. It is of vital importance for health providers to have a specific purpose for employing this vision, instead of getting excited about the hype that surrounds it.

Blockchain could today be useful in several ways, including the management of clinical trials, provider credentialing, processing medical claims payment, Medicare/Medicaid eligibility and as a patient-consent model for health data exchange. This, of course, is dependent upon whether health professionals continue to gain understanding of the software.

SERVICE AS A SOFTWARE

With Service as a Software, or SaaS, both credentialing and enrollments are streamlined. This up and coming trend replaces tedious hours of paperwork with a user-friendly electronic credentialing application, allowing providers to sort through and manage applications quickly and easily. On the payer side, real-time analytics on the credentialing process can be received instantly, and automatic monitoring and re-credential events can be established. Credentialing software will save practices time, money and improve organizational efficiency.

CREDSIMPLE

CredSimple is a trending software dedicated to help with the nation's current increased demand for nurse practitioners (NP's) and physical assistants (PA's) with high credentials. This trend is reflected in an increase in the ratio of PAs and NPs credentialed over the last four years compared to medical doctors. It is important to understand the nuances of credentialing allied health professionals. PAs and NPs are critical frontline healthcare providers with extensive and increasing responsibilities in patient care. They are needed more and more to help address growing volume of patient visits and healthcare utilization. Hence, it is imperative that credentialing PAs and NPs should be of the highest efficiency, quality and accuracy.

How an NP or PA is credentialed is dependent upon how they are contracted. If they are practicing as an independent practitioner, meaning they are able to see and treat patients without supervision from physicians, health plans will need to verify their credentials based on NCQA requirements. This means checking education and training, which includes board certifications. However, if PAs and NPs are not working independently, from both a payer and facility perspective they do not need to be credentialed, and therefore board certification does not need to be verified.

CredSimple helps health plans navigate these nuances. Not only that, their technology allows them to drastically decrease turnaround time by removing a lot of the manual credentialing work (all while increase data accuracy and compliance).

BEHAVIOR HEALTH REGULATIONS

The current trend in behavioral health is that several new pieces of legislation passed in New York State that are changing the healthcare regulations. They now require behavioral health programs to work with credential providers differently and to a higher standard than ever before, including having many behavioral health facilities that didn’t need licenses previously must now have operating certificates. This means a wide range of programs are needed to credential their providers now. CredSimple is one trending software currently helping to improve the quality of behavioral healthcare. There is no information available yet on the exact laws that are going to be passed.

CONCLUSION

To sum up, there are four major trends in the U.S. Provider Credentialing Industry: Blockchain, Service as a Software, CredSimple, and Behavior Health Regulations.
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