The Reasons and Advantages to Outsource Medical Credentialing

The Reasons and Advantages to Outsource Medical Credentialing


There is no denying that the healthcare system is going through a crucial stage, whether it is medical reforms or coping with the Coronavirus pandemic. The ongoing challenges medical practices have to face have been augmented with the Covid-19 outbreak that has overburdened nearly every healthcare organization.

Higher operating cost and ensuring patients get appropriate medical treatments have compelled healthcare administrators to look for cost-effective solutions in every department, whether medical supplies or implementing digital solutions for managing revenue cycle or outsourcing medical credentialing.

Medical insurance is a critical feature of healthcare systems and provides financial protection to people from high and unexpected costs in times of illness or injury. When a person purchases an insurance coverage plan, then he/she can easily set up appointments and get the required treatment without any financial obligation.

The hospital or medical practice, on the other hand, verifies the insurance plan and then bills the amount served on diagnosis, treatment and any post-treatment to the insurance companies to reimburse the healthcare providers.

The Current Outlook of Healthcare System

Healthcare centers face a daunting task to effectively manage the finances with growing costs, whether it is operational cost or payment to healthcare providers for their services. The Covid-19 has significantly added to the pressure as the number of cases is rising, and there is no potential cure in sight.

Most of the hospitals, physician clinics, medical practices, rehabilitation centers, and therapy centers are facing numerous challenges, which includes

  • Administrative burden and Staffing shortages that lead to overtime
  • Updating I.T (Information Technology) structure
  • Controlling rising operational costs
  • Preparing new reimbursement models to prevent payment denials from insurance providers
  • The threat of facing a lawsuit following malpractice

In healthcare, patient safety and well-being are the number one priority and responsibility of everyone from medical practice administration to healthcare practitioners. Millions of dollars of medical grants and financial support, such as reimbursement programs, can be lost if patient safety is risked.

Medical practice has first to ensure the delivery of quality care, and it can only happen if qualified and skilled healthcare providers are employed. To ensure the correct diagnosis and treatment of patients, only credentialed physicians and staff should be allowed to work to prevent any medical malpractice.

In these testing times, hospitals and medical practices need robust and flexible solutions to work efficiently and maintain safety. The solution for medical practices is to automate and outsource. Automating manual tasks by installing digital software and solutions is the best way for medical practices to streamline work, reduce errors, cut costs, and improve efficiency.

The Significance of Medical Credentialing

Today, many hospitals are outsourcing certain in-house tasks that are allowing them to focus on core competencies. Some of the common outsource tasks include food services, laundry, housekeeping, and many I.T related tasks such as transcription, medical billing, and coding.

Credentialing is another task that has been outsourced to help hospitals and medical practices get hold of qualified healthcare providers without utilizing time and resources. Medical credentialing is the process of verifying the complete record of the applicant, which includes Education, Training, Certifications, and Experience.

Medical credentialing is crucial to determine whether the physician, surgeon, nurse, lab technician, or even a therapist is capable and credible to perform healthcare duties expertly or not. Once the credentials are verified, the next step is privileging or granting permission to perform medical, surgical, psychiatric, or other patient care services.

Both credentialing and privileging process is quite labor-intensive, detail specific, and time-consuming as a medical practice has first to gather required information and then filter the candidate according to his/her credentials. The candidate has to be truthful in filling and submitting the application, but it is still the duty of the medical organization to verify all the qualifications and credentials.

The first step in verification is primary source verification (PSV), which refers to obtaining the information directly from the source that has issued the credential. The next step is privileging, which consists of the application being passed through a series of committees such as ‘Department chair review,’ ‘Credentials Committee,’ and then ‘Executive Committee.’ The hospital’s board of directors gives the final approval. Only after final approval, the applicant is granted the privilege to work in the hospital or medical practice.

The Reasons for Outsourcing Medical Credentialing

A medical practice or hospital administrative staff has to juggle different tasks and do not have tools or software and work through multiple spreadsheets, programs, and checklists. However, Credentialing Verification Organizations (CVOs) companies such as PETTIGREW have designed and developed credentialing software. CVOs only focus on verifying the eligibility of the healthcare providers so that the medical practice can emphasize on patient care. The reasons or advantages of why medical practices should outsource credentialing services are

  • Error Free
  • The biggest advantage of automating and using innovative software is the considerable reduction in errors which used to be common in manual processes. According to research, it was noted that healthcare centers using software solutions saw a reduction in complaints, complications, and cost. The modern software automatically checks for errors and filter out the details.

    Outsourcing the credentialing process helps medical practices to focus on patient care and allow CVO to gather, filter, report, and manage the verification process with an unbiased approach. The hospitals or medical practices mostly provide criteria to filter the applicants and ensure fair treatment to healthcare providers applying for the work. The CVOs also stay updated on the changing government regulations, so the hospitals do not have to worry about compliance issues.

  • Cost-Effective
  • Nearly every healthcare center, big or small, has to face budget constraints and difficulty in reducing operational costs and streamlining the processes. Implementing a cloud-based solution can reduce paperwork and errors and not impact patients' health or safety. The data is stored centrally with a cloud system but can be accessed remotely with a low and manageable cost.

    The medical practice can also save millions of dollars on litigation and malpractice cases, ensuring that all the healthcare providers working in their facility are qualified, and their credentials are verified. In many states, there are strict rules, and negligent credentialing is considered as a reason for litigation against the healthcare centers.

  • Quicker Turnaround
  • Outsourcing credentialing services saves time and effort of the healthcare providers and reduces the diagnosis and treatment phase and ensures timely reimbursement. The standard time it takes for healthcare centers to verify credentials is from 60 to 100 days, while CVO can speed up the process and allow surgeons and physicians to work without any worries.

  • Less Paperwork
  • The traditional credentialing process meant numerous paper documents and also numerous files for various healthcare providers. CVO uses sophisticated software with a value-added feature of cloud computing that allows remote access with easy editing, uploading, and sharing instead of filing cabinets.

  • Improved Efficiency
  • In many healthcare organizations, the existing system consists of spreadsheets, paper documents, and checklists spread over different departments. Many of the documents need to be updated frequently, which increases the paperwork. The CVOs run cloud-based systems that help them to verify and update and check for errors easily. Having a central database helps prevent lengthy times in setting up perimeters, giving easy access for analytics.


    The increasing challenges and growing Covid-19 cases have made it difficult for healthcare centers to rely on traditional methods and administrators for medical credentialing. The solution for medical practice is to partner with an established and prominent company such as PETTIGREW for credentialing services.

    Automation does not replace the administrative staff but frees them from challenging duties and focuses on other persistent issues. Automation also reduces human errors significantly and leads to considerable cost savings. When the credentialing is done quickly, then the doctors, nurses, and surgeons can quickly start working and caring for the patients. The data of healthcare providers is maintained securely and can be accessed and shared remotely.