July 23, 2021

OCHIN’s new suite of credentialing services supports equitable access to high-quality care, while reducing burden among community-based health care providers. Read on to learn more from Sarah Gonzalez, Director of Credentialing, about how OCHIN is transforming the medical credentialing process with automation and added quality assurance.

Q: What is health care credentialing and why is it important?

A: Credentialing describes the process of verifying and assessing a provider’s medical qualifications in order to confirm their ability to render quality patient care and/or enroll them to participate with various health insurance plans and get paid for those services. Not only is it a legal requirement, but credentialing is also important because it helps mitigate the risk to health care organizations and ensures that patients are being treated by a provider who is truly qualified and has the necessary credentials to provide a service.

Q: Why would an organization need assistance with credentialing?

A: Credentialing has always been a pain point for organizations because it can be a tedious process; but without it, providers can’t offer care or bill for care, and organization’s lose critical revenue. Many OCHIN members participate in more than a dozen different health insurance plans with different enrollment applications and credentialing processes that must be completed for each of their providers—in some cases that requires dozens of applications across more than 100 providers.

Typically, the smaller, community-based health care organizations that OCHIN supports don’t have the system or the staffing to truly keep up with the credentialing process. For example, most of our members are federally qualified health centers (FQHCs), so they have to do their own internal clinical credentialing to ensure their providers are privileged to render patient care under the requirements of the U.S. Health Resources and Services Administration (HRSA), and then they have to credential and enroll them with each health insurance plan. So, they have to do credentialing twice, essentially, and provide updates to fulfill ongoing maintenance or renewals.

OCHIN has a system and a platform to help automate that process with a single standard credentialing application that eliminates that duplication of effort and eases the administrative burden on providers, as well as clinic staff.

Q: What types of credentialing services does OCHIN offer?

A: OCHIN now offers two types of credentialing services to support providers and the health care organizations where they work.

1. Provider Enrollment Service, which includes the initial credentialing and recredentialing work involved with ensuring that providers are enrolled with health insurance plans. That service also includes ongoing maintenance support, sanctions monitoring, and monitoring expirables. For example, we have the capability within our platform to automate reminders for providers to renew their medical licenses, DEA/CDS registrations, malpractice insurance, etc., before their expiration and then update that information directly through the portal, so it’s always current.
2. Credentialing Verification, which entails gathering all of the application information and performing primary source verifications for the health center or facility to complete their own internal credentialing and privileging. OCHIN doesn’t make credentialing decisions, but we do the heavy lifting of gathering and vetting information to help organizations complete their credentialing files for board review and approval.

Q: What are the primary benefits for health care organizations, as well as for providers and their patients?

A: For care organizations, OCHIN Credentialing Services support improves the speed and accuracy of their credentialing process to reduce cost and risk, while freeing up staff resources to focus on patient care. One of the things that sets OCHIN apart, is that we’re not just collecting information to fill out enrollment applications. We’re also providing quality assurance by verifying training, employment, or certification information in the same way that a health plan would and red flagging any discrepancies, or even outstanding liability cases, that would identify someone as an a-typical provider. By doing those verifications and alerting organizations, OCHIN helps ensure that, at the end of the day, patients are going to have a quality provider.

Our user-friendly platform makes credentialing easier for providers as well, with a single electronic intake form that is used to auto-populate across various applications and eliminate the redundancy otherwise needed to complete multiple paper applications. It’s also mobile-friendly, so providers are able to complete their applications digitally and upload documentation directly through their smart phones or tablets. That, as well as the automation that we offer, will certainly ease their burden.

Q: How does OCHIN’s credentialing program help promote health equity?

A: You shouldn’t have to make a certain amount of money to see a quality provider. The process of doing credentialing helps ensure that ALL patients have access to quality care and qualified providers—that there isn’t any disparity in care based on income or where you’re able to seek treatment based on your insurance type.

Q: Who may apply and where can interested organizations go to learn more?

A: OCHIN’s credentialing services are open to anyone nationwide. There are no OCHIN Epic platform requirements and organizations do not have to be current members of the OCHIN network to apply for support. To learn more or apply, please visit https://ochin.org/credentialing.