In today’s healthcare systems, credentialing delays can take up to 120 days. This slow procedure not only costs organizations thousands but also compromises the safety of their patients. This is why knowing the difference between credentialing and privileging is important to maintain provider competency as well as quality care.
In this guide, we will share how automation improves both credentialing and privileging operations, and how, with improved compliance, you can experience accuracy, as well as efficiency in your procedures.
Credentialing is the procedure used by healthcare providers to confirm a provider’s qualifications, whereas privileging is allowing the providers to perform specific procedures. Incorporating both of these procedures helps in protecting your patients and upholding operational integrity in healthcare.
This is why tools from service providers like Provider Passport’s automation simplify these processes, minimizing delays and errors. Thus, transforming credentialing and privileging in healthcare into faster, more reliable, and scalable operations.
Understanding the Credentialing Process
Steps in the Credentialing Process
The process starts with filling out the application. Then, primary source verification takes place to confirm licenses, certifications, education, and work history.
Additional steps often include:
- Malpractice review
- Peer references (when required)
- Submission of the application to the credentials committee for final approval
Regulatory bodies, such as The Joint Commission and NCQA, legally require these steps to verify a provider’s qualifications. This guarantees the provider meets the standards to practice.
Why Credentialing Takes So Long
The length of credentialing is partly due to the number of touchpoints. Each step in credentialing requires correspondence between providers, previous employers, associations, and boards of state, and credentialing committees.
When one of these parties does not respond in a timely manner, the timeline is delayed. After that, a healthcare organization must chase after the missing documentation, which only adds to the timeline.
Another factor is a lack of standardization across states and health systems. In one state, what might be an acceptable verification may not work in another. When there is enough deviation, providers and administrative staff must retrace evidence. This process is both frustrating and time-consuming.
Challenges in Credentialing
Manual credentialing tasks often create heavy administrative burdens. These challenges typically include:
- Data entry errors that compromise accuracy
- Delays that extend up to 120 days
- Slowed provider onboarding processes
- Increased costs for healthcare organizations
These issues show why process efficiency is critical for healthcare institutions.
The Human Cost of Inefficient Credentialing
Furthermore, long delays in the credentialing process have a direct impact on patient access. Your new physician may be poised to begin work, yet is prohibited from seeing patients until the final decision is sealed in approval. This results in your hospital being short-staffed, and patients waiting for additional time.
In a private practice, lost revenue is incurred during this wait, as providers cannot bill for their services until the credentialing process has been completed. Slow credentialing will also displace providers needing work, as these organizations may be competing to hire an individual, and if one organization is taking too long, others with quick credentialing processes will outpace the competition.
The Role of Automation in Credentialing
Automation streamlines the credentialing process by providing opportunities for real-time tracking and digital attestations. It increases accuracy, improves transparency, decreases errors significantly, and allows newly qualified providers to credential faster and start delivering care to patients sooner.
What is Privileging and How Does it Relate to Credentialing?
Privileging is the conventional procedure that healthcare institutions use to provide specific responsibilities to providers. While credentialing and privileging are generally discussed together, they serve distinct and separate purposes.
Privileging helps in defining the scope of practice a provider can perform within an institution. Combined with credentialing, these two procedures work together to make sure the patients are in safe and reliable hands and strengthen regulatory adherence in a healthcare setting.
The Privileging Process
The procedure begins by reviewing credentials, followed by peer evaluation and committee approval. When the provider’s competence has been confirmed, only then are privileges offered. Plus, the ongoing performance monitoring makes sure credentialing and privileging remain accurate and up to date.
Types of Privileges
Privileges differ depending on specialty, provider role, or care setting. Common types include:
- Admitting privileges — allow a provider to admit patients into the facility
- Surgical privileges — permit the provider to perform surgical procedures
- Courtesy privileges — cultivate limited practice without full responsibilities
Credentialing vs Privileging – Key Differences and Overlaps
Credentialing vs Privileging
As mentioned, this procedure allows healthcare institutions to verify the information from the provider before they start giving care. Afterwards, when everything has been confirmed, the provider is granted authority to perform specific procedures in the facility. In short, credentialing always precedes privileging, guaranteeing compliance and patient safety.
How Automation Can Improve Both Processes
With automated privileging and credentialing software, Healthcare facilities are able to automate verification, documentation, and approval processes with ease. Similarly, these tools improve productivity at large by minimizing administrative hassles through real-time status tracking. This results in fewer onboarding delays for qualified providers.
Additionally, it also provides a reliable digital trail so that every step can be audited to promote proper stewardship practice when necessary, thereby building trust with regulators and payers. Because of the reduced burden of manual paperwork, there is less opportunity for errors due to data entry, and the built-in alerts keep administrators informed on upcoming renewals or missing documentation.
Overlap and Confusion Between Credentialing and Privileging
Although completely different, credentialing and privileging generally get confused since both procedures involve verification and compliance.
However, with the help of automation, healthcare institutions can easily distinguish the two operations and stages clearly, reducing costly errors and processing delays.
A Comprehensive View of Credentialing vs Privileging
| Aspect | Credentialing | Privileging |
| Definition | Verification of qualifications, licenses, and experience. | Granting permission to perform specific procedures. |
| Timing | Conducted before privileging. | Follows credentialing approval. |
| Focus | Background checks and compliance validation. | Scope of practice and facility-specific approvals. |
| Key Stakeholders | HR, compliance, and credentialing teams. | Medical staff office, department heads. |
| Automation Impact | Faster verification and centralized documentation. | Quicker approvals and real-time privilege tracking. |
Key Factors for Ensuring Compliance through Credentialing and Privileging
Regulatory and Accreditation Requirements
The privilege and credentialing methods will need to align with the high requirements required by The Joint Commission and CMS. When an institution attains compliance with these parameters, it not only serves to promote patient and organizational safety but also boosts the organization’s credibility and operational integrity.
The Role of Continuous Monitoring
Inspections like OPPE and FPPE are needed to make sure providers maintain their performance. Furthermore, these periodic reviews help encourage compliance while also establishing trust in the organization through its operations.
Leveraging Technology for Compliance
Real-time dashboards, automations, notifications, and audit preparation tools have made the compliance process much more efficient through modern software platforms. These platforms help in making credentialing and privileging processes much more effective with fewer manual errors and empower teams to stay ahead of compliance issues.
Staff Training and Education
Compliance does not only focus on systems and policies, but also on the people involved. When engaging in the training of administrative teams, credentialing specialists, and providers routinely, there is a likelihood that they will have an understanding of the current regulations and best practices.
Provision of ongoing training through workshops, published/updated guidelines, and availability of support resources that help fill in the gaps can help minimize knowledge gaps in relation to compliance and limit avoidable compliance errors.
Documentation and Audit Readiness
Accurate and complete documentation is essential to compliance. Your organisation must have a systematic approach to documentation and guarantee that documentation is maintained appropriately from credentialing packets to reappointment files, so that it can confidently withstand regulatory scrutiny.
Moreover, by preparing for the audit ahead of time, i.e., keeping documents standardized, current, and easily accessible, you’ll reduce the stress level when surveyors arrive and demonstrate a culture of accountability.
Departmental Integration
Credentialing and privileging never work in a single solution. There must always be coordination with the medical staff offices and compliance,i.e., HR, and departmental leadership. Guaranteeing workflows are integrated across departments allows the facility to stay consistent, to limit duplicated efforts, and to uncover gaps before they become compliance issues.
The Impact of Proper Credentialing and Privileging on Quality of Care
Patient Safety and Provider Competency
For credentialing and privileging, practitioner credentialing is making sure healthcare practitioners satisfy all educational and licensing requirements. It is a simple check to show they are capable of providing quality care; this maintains patient safety and consistency in the care delivered.
Reducing Legal and Financial Risks
Healthcare providers can easily avoid malpractice suits, fines from regulators, and maintain their accreditation simply by using credentialing and privileging processes.
In fact, when institutions can maintain their operations proactively, it allows them to save money and shield their reputation whilst also making sure their credentialing standards stay strong, something that’s necessary for keeping the whole operation running smoothly.
Strengthening Organizational Reputation and Trust
A strong credentialing organization facilitates trust within the community and strengthens professional credibility. Patients tend to choose the facilities that show transparency and rigorous quality assurance.
Similarly, relationships with insurers, regulators, and referral pathways are strengthened when organizations exhibit a high reliability for provider verification. Building credible recognition takes time, but it ultimately leads to continuous growth and patient loyalty.
Improving Operational Efficiency in Healthcare Delivery
When credentialing and privileging are thorough and accurate, they can create efficiencies across all departments.
Clearly defining provider qualifications and scopes of practice allows administrative teams to minimize delays associated with scheduling, billing, and compliance reporting. This clarity can remove bottlenecks, use time more efficiently when providing patients access to care, and improve the provider’s time spent on patient clinical outcomes rather than managing paperwork.
Future-Proofing Credentialing and Privileging Through Automation
Knowing the difference between credentialing vs privileging is important to guarantee healthcare institutions are compliant and competent. Integrated automation from service providers like Provider Passport, whose solutions simplify both procedures. With the help of their artificial intelligence and ML, forward-thinking healthcare institutions can improve their accuracy and regulatory readiness for the future.
FAQ
How can small healthcare practices benefit from credentialing automation?
Utilizing automation would lessen administrative burden, speed up verification and overall cost efficiencies, which may allow a small practice to become more efficient as an organization.
How can automation help address incomplete or missing documentation in credentialing?
Automated systems will send reminders of missing items, collect documentation in one application, and even reduce the number of tracking errors, thus completing applications sooner.
Can automation help with credentialing for non-traditional healthcare roles (e.g., telehealth providers, nurse practitioners)?
Yes, automation can adapt to different provider environments, which can help with the credentialing process for new types of providers in a changing healthcare environment.
What is the biggest advantage of automation in credentialing and privileging?
The biggest benefit is that providers who are qualified can be onboarded faster, and patients can get greater access to care.