Streamlining Multi-State Credentialing for Healthcare Providers

The credentialing process of healthcare professionals is multifaceted especially when dealing with providers who have multi-state licensing. For instance, while considering multi-state credentialing, a relatively straightforward credentialing process that may take several months with a single-payer becomes particularly difficult. There are more states than territories in the US, and thus more organizations; thus, the first problem that must be overcome for interstate medicine to thrive is all of the various reimbursements from all of the organizations in question. Whether through multiple physical sites or telehealth services, there are multiple healthcare organizations throughout the US, and each state has its regulatory statutes. 

 

This article aims to provide details into the multi-state credentialing and enrollment process, its challenges, and ways of easing the process.

Challenges in Multi-State Credentialing

Before a healthcare provider can bill a patient for services rendered or become a part of a payer’s network, the process of credentialing such a provider encompasses the examination as well as the validation of the provider’s qualifications and credentials. However, the task of credentialing a provider can become increasingly elaborate when a provider practices medicine across multiple states. Multi-state enrollment, among other things, comes with its own distinctive set of challenges that have been explicitly listed in the space below:

1. Lack of Visibility Across Locations

Among decentralization, the biggest issue is the absence of knowledge regarding the credentialing process residing in a web of different states. A centralized or tracking system to monitor the progress of the process can be useful in allowing management to understand where each state stands in terms of the credentialing process. 

2. Diverse Requirements Across States

Healthcare providers face challenges due to varying state credentialing requirements. This can lead to errors and delays. For example, in New York, Medicaid credentialing requires providers to complete a specific enrollment form and undergo a background check through the Office of the Medicaid Inspector General (OMIG). In contrast, California mandates compliance with Medi-Cal’s unique provider enrollment process, which includes fingerprinting for certain provider types and additional state-specific forms.

 

3. Lengthy Procedures

Provider credentialing is a time-consuming process, and the delays associated with it can be significant. A study by the Medical Group Management Association (MGMA) found that the average time to complete the credentialing process for a physician is 90-120 days. However, this timeframe can vary depending on the complexity of the provider’s background, the efficiency of the organization’s credentialing process, and the completeness of the provider’s documentation

4. Resource Constraints

However, when dealing with multi-state credentialing, some more issues arise. One of them is the lack of resources to address the task at hand. Quite a few organizations fail to maintain enough adequately trained employees, resulting in a staffing issue. This study, conducted by the National Association of Credentialing Services (NACS), found that a lack of adequate resources, including staff and technology, can lead to significant challenges in the credentialing process. 

5. Communication Barriers

Cross-state communication with payers and regulators is vital for organizations engaged in multi-state credentialing. Unfortunately, this is much easier said than done as different states have different time zones, use varied forms of communication, and even have different processes. A study conducted by the American Medical Association (AMA) found that communication barriers between healthcare providers, payers, and regulators can lead to significant delays and inefficiencies in the credentialing process.

Strategies for Improving Multi-State Credentialing Process

Considering the numerous difficulties faced by the healthcare sector every day in multi-state credentialing, it becomes clear why perfect practices in such matters would be of great benefit. The following five tips can help healthcare organizations achieve credentialing in multiple states in an efficient and faster way:

1. Centralized Credentialing Documentation

For an efficient experience every time, every business should keep its credentialing documentation in one place. Each time a payer plan is provided, through the creation of a master document template that has a checklist of documents, our healthcare organization can be assured of having submitted everything required. This study, conducted by the American Medical Association (AMA), found that centralized credentialing databases can significantly reduce the time and cost associated with provider onboarding. This allows the organization to fulfill its deadlines more accurately by reducing the chances of misplaced documents and speeding up the entire process.

2. Create Consistency in Credentialing Regardless of the State

Healthcare organizations should employ uniform credentialing processes in all states to ensure that variability is limited. A study conducted by the National Association of Credentialing Services (NACS), found that organizations with standardized credentialing processes experience shorter turnaround times, reduced administrative costs, and improved provider satisfaction. A properly trained team is needed to avoid miscommunication, mistakes, and delays.

3. Use Scheduler for Credentialing Tasks

Provider credentialing can be simplified by having a calendar for all the consolidation processes. This makes it possible for the organizations to see the peak times and allocate the resources in accordance. This study, conducted by the Medical Group Management Association (MGMA), found that organizations that utilize scheduling software for credentialing tasks experience shorter turnaround times, reduced administrative costs, and improved provider satisfaction.

4. Eliminate the Need for Repetitive Actions

This includes exclusion database checking, last resource credentialing, and license renewal among other things and all of them can be automated. Implementation of these changes would help organizations save time and minimize the chances of blunders. Credentialing software can automatically check provider information against national and state exclusion databases (e.g., the National Practitioner Data Bank, the Office of Inspector General (OIG) database) regularly.

5. Oversee and Evaluate the Process of Credentialing

To ascertain compliance and spot non-conformities with the intent of taking corrective actions, it is important to review and audit the activities of the credentialing process continuously. Through a centralized reporting system, organizations can monitor the status of credentialing activities in real-time which enables the upper management to gain an all-encompassing picture of what is taking place at all aspects within the organization. Carrying out regular audits of the credentialing process helps manage the risks that all regulatory requirements are being followed and any problems that would arise are dealt with in an early stage to avoid bigger issues in the future.

Common Requirements for Multi-State Medical Licensure

When seeking multi-state provider network licensure for healthcare providers, understanding the general requirements set by most state medical boards is key. Here are some of the common requirements:

• Proof of Graduation from an Accredited Medical School: All states require providers to prove that they graduated from a recognized medical institution.
• Proof of Residency: Many states require proof that the provider has completed at least one year of residency training in their medical field.
• Licensing Exams: Passing an approved licensing exam is a critical step in obtaining licensure in multiple states.
• Payment of Licensing Fees: Each state has its own set of fees for medical licensure applications.
• Criminal Background Check: Most states require a criminal background check as part of the credentialing process.

How to Start the Multi-State Medical Licensure Process

The process of obtaining multi-state licensure begins by securing a license in your State of Principal Licensure (SPL). To qualify for multi-state licensure, providers must meet specific criteria, including having their primary residence in the SPL and conducting at least 25% of their medical practice in that state. Once these criteria are met, providers can apply for licensure in other participating states through the Interstate Medical Licensure Compact (IMLCC).

Becoming Licensed through the Interstate Medical Licensure Compact (IMLCC)

The IMLCC is a streamlined process that allows eligible physicians to obtain licenses in multiple states through a single application. Participating states agree to accept each other’s vetting processes for medical licenses, which significantly accelerates the credentialing process for physicians. By choosing an SPL, physicians can apply for licensure in as many participating states as they wish, making multi-state practice more accessible.

How Health Quest Billing Can Support You

Health Quest Billing assists providers in the multi-state credentialing and licensure processing and therefore partnering with Health Quest Billing enables scheduling companies to assign their licensing specialists to take care of all the credentialing. Our team aids in payer communications, deadline tracking, and understanding the interstate filing requirements to refrain the providers from the complex processes of credentialing and focus on the actual patient care.

With great focus comes precise work. Our supportive techniques help physicians and other medical practitioners be guided on every requirement needed in the four-pronged modality (collecting documents, collecting the application, submitting the application, and licensing).

Final Thoughts

Without a doubt, credentialing physicians across the nation has proven to be daunting as well as tedious, but with appropriate measures at hand one can make it less overwhelming. Centralization, document standardization, setting up of reminders on calendars, automation, and regular auditing can go a long way in ensuring that the systems credentialing processes are effective and more importantly time conscious. Furthermore, whether one’s dealing with medical practices in various regions or offering telemedicine, the best practices mentioned above will ease the credentialing process while effectively optimizing operational metrics.