Remember the time when you were just about to raise the claim for services provided by the provider from your organization and realized that his credentialing is not current? Not only this results in delaying the claim process but sometimes exposes your organization to legal risk. While every attempt is made to keep the provider credentialing current, the process typically takes about two months and always behind the schedule. It involves getting information from a diverse set of sources and collecting that manually, reconciling takes the time. That’s where provider credentialing automation comes in.

The truth is medical facilities that have the latest technologies for onboarding new providers often beat their competitors and hire top talent first. The companies that adopt credentialing automation early will likely maintain an edge over their rivals.

The need for Credentialing Automation process:

When it comes to credentialing, most organizations still rely on outdated, time-consuming, and potentially inaccurate approaches. In fact, it is estimated that nearly 70% of those performing front-line credentialing are using some type of paper-based system or homegrown spreadsheet or database providing limited automation and little added efficiency.

Why does this matter? Because it’s impossible to get quick answers when relying on pencil-and-paper credentialing approaches. It can typically take anywhere from one to three months to receive responses from past employers, centralized professional bodies, peer references or schools with essential credentialing information. Long lag times can make it more difficult to hire the most qualified staff if more sophisticated competitors are able to complete the credentialing process more quickly and accurately and move faster to hire the best providers.

Automated credentialing suites can solve these problems by permitting instant management of the credentialing process. Automated credentialing can provide instant access to national databases (eg, National Practitioner Data Bank, Office of Inspector General) on which performance, employment, and education information are stored. Automated approaches can provide significant time savings.

Main features of credential verification bot:

  • The process of credentialing can be initiated via three ways which are, a scheduled process, a user-initiated and event-based invocation of the process. An Orchestrator Bot is used to start the process where the credentials of a provider can be verified.
  • The Provider Bot: This bot gets lists of one or more Providers eligible for verification from the Local Provider Database along with the latest demographic/personal information for each provider.
  • History Analyzer Bot: This bot checks and analyzes with the past history of the provider which is already present in the database and updates if any new information is available on the provider in the database accordingly. The history analyzer bot works along with the provider credential eligibility history.
  • Verification Bot: The verification bot invokes the verification process after all the credential eligibility is checked.
  • Discovery Bot: A number of bots used to check licenses and certifications, background/criminal history, malpractices and disciplinary actions, sanctions/work history, employee references of the provider.
  • Collator Bot: All the verifications and checks performed are collated in a result document where the status of the verification for each of the provider is provided in the document.
  • Communicator Bot: The results need to be shared with credentialing specialists. The status of the verifications performed for each provider is sent through notifications and emails to the credentialing specialists.

At a time when there is more focus than ever on healthcare quality, organizations should be paying more attention to credentialing, the gateway to quality. By making credentialing efforts more effective and efficient, the organizations can ensure that the most qualified and experienced professionals provide patient care. At the same time, the organizations can improve their reimbursement rates and guarantee more timely payment for the services they provide.

Flologic Automation provides a credentialing solution which is catered for your organization and simplify your needs. Email us at