How Intiva Health Changed the Medical Credentialing Process

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Intiva Health, based in Austin, Texas, describes its mission as “improving the health of healthcare,” which it aims to accomplish primarily through its free medical credentialing software Ready Doc™.

The platform provides a centralized repository for digital documentation pertaining to healthcare credentials, medical licenses, malpractice insurance proof, and other documents relevant to healthcare professionals. 

Standard methods of credentialing include manual and electronic spreadsheets, paper folders, and other software. Many of these methods can still take several weeks, if not months, to complete the credentialing process.

Ready Doc™ features:

  • Automated payer enrollment
  • Centralized repository for healthcare provider credentials, other documents
  • Healthcare provider roster management
  • Continuing Medical Education courses
  • Expiration alerts
  • Ability to request information directly from providers and track the status
  • Custom and pre-formatted digital forms
  • Electronic signature capabilities

Ready Doc™ uses Hashgraph distributed ledger technology (DLT) to create a secure, online platform for medical credentialing—which also generates immutable timestamps to expedite the process. These timestamps are crucial to the credentialing process as they aid in primary source verification concerning the validity of the documents—one of the cornerstones in healthcare credentialing.

Why medical credentialing is important:

Credentialing is a process that involves the collection of a healthcare provider’s educational background, medical licenses, medical malpractice history, and a slew of other documents to validate their ability to practice medicine. Following primary source verification of the data, medical facilities can attest to the quality of healthcare offered to their patients and avoid mishaps, fraud, compliance breaches, and more.

With the multitude of documents that need to be collected, processed and verified, credentialing is primed for improved efficiency with the help of a digital platform such as Ready Doc™.

Aside from efficiency, a credentialing software reduces administrative burden for everyone involved. A Johns Hopkins University study claims more than 250,000 people in the United States die every year from medical errors. On average, medical errors are the third-leading cause of death in the United States following heart disease and cancer.

Nonetheless, healthcare facilities continue to use slow, manual, and paper-based credentialing methods that are prone to error and guarantee complete transparency and validity of providers’ credentials.

According to the National Association of Medical Staff Services, while the standards for credentialing may differ depending upon the accrediting organization, the process is complex and human error is bound to occur. One simple error due to a pile of paperwork may result in a healthcare provider performing services that are beyond their scope of practice or a physician providing patient care despite an expired license.

All of the above as well as numerous other possibilities that can result from human error tied to physician burnout stemming from manual credentialing methods can have serious consequences related to a healthcare professional’s career, the reputation of a medical facility, as well as patient safety and trust.

Lack of understanding:

Hospitals and other healthcare organizations have traditionally viewed credentialing as a check-the-box regulatory burden and have largely overlooked the benefits of a streamlined approach. Without an understanding of the cost benefits, risk mitigation and general efficiency of an electronic credentialing system, it’s no wonder that most healthcare organizations only check credentials at the time of hire and then once every two or three years. More continuous monitoring is neglected because of the time and cost involved with manually validating employee records against various primary sources. In many cases, manual data acquisition and verification on a single provider can take anywhere from several days to several months to complete.

The good news is that complex and evolving regulatory reform has placed renewed importance upon health care organizations to invest in automated credentialing that expands access and meets benchmarks for improving the quality of care while reducing overall costs.

At a minimum, the solution must provide for electronic data capture to collect and manage provider data, constantly verify background information, generate online reports and statuses, and complement all aspects of credentialing while following regulatory requirements offered by NCQA, URAC and the Joint Commission.

In response to the challenges of manual processes, electronic credentialing eliminates errors and reduces labor costs by allowing organizations to screen practitioners in real time. Healthcare administrators are expected to ensure greater patient safety, protect their institutions from financial harm, and ultimately reduce costs. All of these goals can be accomplished via a proper credentialing software. 

After a healthcare provider completes the credentialing process, they still need to get paid. This is where enrollment comes into play. A proper credentialing software, such as Ready Doc by Intiva Health, should automate payer enrollment and enable providers to treat more patients. 
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More work to be done:

Healthcare administration does not stop after a provider has completed the credentialing and enrollment process. Ready Doc™ also offers several compliance features including monitoring for exclusion and sanctions from several state and federal databanks, such as the Office of Inspector General’s (OIG) List of Excluded Individuals/Entities (LEIE).

The U.S. Department of Health and Human Services established the OIG to identify and eliminate fraud and abuse. The Health Insurance Portability and Accountability Act (HIPAA) authorized the OIG to provide guidance to the healthcare industry to promote lawful conduct—which the department conducts through a nationwide program of audits, inspections, and investigations. Anyone that is found in violation is placed on the LEIE. 

Any healthcare provider or medical facility can land on the LEIE and have their career potentially impacted for life—which makes continuous monitoring of the list akin to monitoring one’s credit score and identity. A feature such as continuous monitoring of exclusion lists allows facilities and healthcare professionals to concentrate on providing a superb level of patient care.

Keeping HIPAA in mind:

More than a year and a half ago, the federal government issued a Notification of Enforcement Discretion for telehealth communication in response to the COVID-19 Pandemic—allowing healthcare facilities and physicians to use standard communication apps, such as FaceTime or Skype, to deliver patient care. The waivers also relaxed the informed consent requirement for telehealth, yet this will likely be reinstated as well. Throughout the pandemic it is standard for healthcare providers to obtain verbal consent from their patients, which will soon no longer be compliant. Healthcare facilities must obtain consent from their patients via another method, such as in writing or a digital signature on an electronic form.

There is currently no set expiration date for the HIPAA waivers, yet experts believe the rules are bound to return and healthcare professionals must be prepared to remain in compliance or risk massive monetary penalties. 

It is also important to note that throughout the COVID-19 pandemic, legal requirements for security of protected health information (PHI) under the HIPAA Privacy Rule remained in place. Facilities and providers remain responsible for protecting the health information of their patients, through clinical communication within a facility as well as outbound communication directly with a patient. 

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