It is well-established that practitioners must be credentialed before seeing patients and billing for services. However, what is less frequently discussed is that facilities must also undergo credentialing.
Payers need to verify the credentials of the provider facilities where patient care is conducted, ensuring they meet quality and safety standards. The challenge is that facilities are fewer in number compared to practitioners, making available solutions scarce. For instance, a network might have 50,000 individual providers and only 50 facility providers. Ask any credentialing specialist, and they will likely tell you that those 50 facilities are their biggest pain.
Using practitioner credentialing software for facilities is less straightforward. Facilities require different documentation and primary sources, and unique regulations dictate how they can or cannot be verified.
At Verifiable, we recognized that this process is arduous and it doesn’t have to be. This is why we’ve designed our facility credentialing solution to save credentialers time and effort, avoid redundancies in data, and give leaders visibility into their entire provider network.
Background: What is Facility Credentialing?
Also known as “organizational providers,” facilities are the physical locations where medical services are delivered to patients, and may include:
- Hospitals
- Home Health Agencies
- Freestanding Surgicenters / Surgical Centers
- Sleep Medicine Centers and Labs
- Skilled Nursing Facilities
- Community Mental Health Centers / Substance Abuse Centers
- Hospice Centers
- …and more
Facility credentialing is required for payer enrollment, so the onus is on the payer side to oversee the credentialing process unless they have a delegated agreement in place.
What are the Requirements for Facility Credentialing?
Similar to practitioners, to be credentialed as an in-network facility with a health plan, the organizational provider must have primary sources verified for various standards. While the requirements list may look similar, it also has very unique distinctions from individual providers.
Facility Credentialing requirements:
- State Healthcare License: All licenses must be current and unrestricted. This confirms that the facility meets state regulations for healthcare services.
- Accreditation Certification: An applicable, recognized accrediting body, such as The Joint Commission has signed off on the facility. Accreditation serves as a quality indicator that the facility adheres to high standards of care and operational excellence. some text
- If the facility is not accredited, then a site survey must be completed by the state or CMS within the last three years.
- Free From Exclusions and Sanctions: This ensures that the organizational provider has not been excluded from participating in Medicare, Medicaid, or other federal programs due to misconduct.
- Professional Liability Insurance: To protect against potential claims made against any employees, this covers legal costs and damages if the facility is sued for malpractice or negligence.
What Makes Facility Credentialing So Difficult?
Optimizing for faster and better facility credentialing has some challenges. However, it’s not because facility credentialing is particularly unmanageable. The reason is simple: improving facility credentialing hasn’t been an industry priority. Compared to the volumes of individual provider credentialing or physician credentialing solutions, facility credentialing makes up a tiny fraction.
With few off-the-shelf facility credentialing solutions available—or physician credentialing solutions being applied to less-than-ideal use cases—credentialing has been clunky. Both repurposed provider credentialing solutions and complex manual data entry comes with a high risk of error. Plus, it’s labor-intensive, leads to credentialing delays, and frankly, is a frustrating experience for health plans and care organizations.
On top of it all, facilities are often credentialed by the same team of credentialing specialists but through different systems. This can limit network visibility and lead to data silos that make it difficult to gain a strategic, comprehensive view.
What’s Unique About Credentialing Organizational Providers?
While both facilities and individual providers must be credentialed, there are key differences. Facilities are more diverse, with unique attributes, which makes credentialing and data management more complex.
- Intake: Facility credentialing is not one-size-fits-all—credentialing documents aren’t always managed by one person like they are with individual providers. This requires credentialists to source documents from multiple places, making the intake process far more complicated.
- Multiple Specialties: One facility can have multiple specialties that each require credentialing (one facility could have 10-15 specialties!).
- Shared Credentials: A single facility with one address might hold a single DEA license and liability insurance, but its multiple specialties can share those credentials. In addition, a facility can also have multiple NPIs due to its specialties and different service offerings.
- Combined Credentialing Events: For facilities with multiple specialties that have shared credentials, combining verifications into a single credentialing event can be a tremendous time saver. Without a system designed for this unique workflow, you can run into a lot of duplicative work.
Overcoming the challenges of facility credentialing and getting to realize the impact of operational efficiency and network visibility requires the right software solution.
Facility Credentialing with Verifiable
Optimize your credentialing workflow with facilities and practitioners managed in one place
We believe that credentialing speed and accuracy can go hand in hand without sacrifice – for individual and organizational providers.
Addressing this need is an important step for us to advance our automation platform to save credentialer time and effort, avoid redundancies in data, and give leaders visibility into the entirety of their provider network.
With the Facility Credentialing Suite, you can:
- Gain clear visibility of your provider network in its entirety
- Facilities and practitioners managed in the same system
- Avoid redundancies in data and streamline duplicative work
- The data model is specifically designed for facility attributes like shared credentials, multiple specialties, and more.
- Save credentialer time and effort without sacrificing quality
- Auto-generate compliant credentialing packets
- One verification for shared credentials
With our pre-built application on the world’s #1 CRM, Salesforce, Verifiable is able to create a single source of truth for all provider network data. Offering health plans the micro and macro view that’s needed for performance optimization.
If facility credentialing data is hindering your provider network visibility and efficiency, we’d love to discuss your goals together.
Want to learn more about credentialing solutions for your organization. Schedule a Conversation.
