How to Streamline Physician Credentialing with Medallion

We’ll be short of 37,800 to 124,000 physicians by 2034, significantly impacting access to care. Obviously, the bottleneck lies in the supply of physicians. However, one area that may help increase the number of active physicians is streamlined physician credentialing.

Now more than ever, we need to swiftly onboard qualified physicians to their care roles, as any delay in the credentialing process further strains the already tenuous access to care.

In this article, I’ll highlight the intricacies of physician credentialing, detail how Medallion is setting the Gold Standard for efficiency and accuracy in credentialing, and offer my take on the company from clinical and systems perspectives.

The Deets: Physician Credentialing

Physician credentialing is a rigorous process typically undertaken by healthcare institutions and insurance providers to ensure that physicians meet all necessary qualifications and standards to deliver safe and effective care.

Such credentialing includes verifying the following:

• Educational backgrounds

• Residency training

• Licenses and certifications

• Professional experience

It shouldn’t surprise you that the current state of credentialing is characterized by an overwhelming reliance on outdated, paper-based, and manual methods, resulting in excessive paperwork, inefficiencies, and inaccuracies. The credentialing process itself is relatively straightforward, but the duration of this process can vary widely, from a few weeks to several months. It all depends on the complexity of the physician's background and the efficiency of the credentialing system in place. 

However, efficiency isn’t the only concern — accuracy is equally important. Manual methods and siloed platforms increase the likelihood of errors, from data entry mishaps to oversight in verifying credentials. So, these two challenges of speed and precision highlight the need for a more refined, streamlined approach to credentialing where efficiency and accuracy are priorities.

Here’s what the process looks like:

1. Data Collection: Collect personal and professional information from physicians, including education, work history, and certifications.

2. Primary Source Verification (PSV): Verify the authenticity of the physician’s credentials directly from the original sources, such as universities and licensing boards.

3. Credentialing Committee Review: A committee evaluates the physician’s qualifications and verified credentials to determine their eligibility to practice within an organization.

4. Roster submission: Submit the physician’s credentials to insurance companies for inclusion in their networks and eligibility for payment.

5. Ongoing Monitoring and Re-credentialing: Continuously monitor the physician’s credentials and conduct periodic re-credentialing to ensure ongoing compliance and qualification.

Beyond the goal to weed out unqualified individuals, streamlined credentialing processes can significantly enhance healthcare delivery by expediting the onboarding of capable physicians, thus addressing the urgent need for medical professionals in the face of growing shortages.

Medallion: Gold Standard Credentialing

Medallion is an integrated platform that streamlines the most complex and burdensome aspects of healthcare operations from licensing and enrollment to physician credentialing. When it comes to credentialing, their focus is squarely on overcoming the traditional hurdles of accuracy, delays, and compliance, ensuring the credentialing process is not just quick but also error-free.

In other words, Medallion is setting the Gold Standard in the credentialing space.

Medallion’s platform has pre-built integrations to thousands of primary sources, allowing organizations to automate primary source verification and speed up credentialing (it also eliminates the need for physicians to fill out endless forms!). Their system will auto-check state licenses and board certifications, as well as check sanctions to ensure disqualified providers are out of networks. Medallion sends automated alerts about important physician eligibility changes, helping you manage risks and stay within regulations.

In my opinion, here’s where Medallion stands out:

Primary Source Verification

This step is ripe for automation, and it's where Medallion really shines, transforming it into a process so swift. Medallion seamlessly verifies essential credentials such as DEA registrations and state licenses, tapping into key industry databases like the Office of Inspector General, ABMS Board Certifications, and National Practitioner Data Bank. This automated and precise approach to verifying key aspects of a physician’s professional standing not only accelerates the credentialing process but also significantly enhances its reliability. 

Quality Assurance

The QA process is where Medallion flexes its technological muscles, automating the validation of accuracy with built-in compliance business logic and computer vision that scans through primary sources, flagging any deviations from set guidelines. With this approach, Medallion has instilled a level of confidence in its clients that's unheard of in the tech-enabled credentialing space.

Committee Management

The final piece of the puzzle is presenting all this back to the client, where Medallion's committee management and digital credentialing files come into play. These automatically generated files highlight key information, ensuring that everything is in order and ready for client approval—the last step in a process that redefines what it means to be thorough.

All-in-One Platform

By offering a single platform that manages the entire credentialing journey end-to-end, Medallion alleviates the administrative burden on healthcare providers, allowing them to focus more on patient care. The platform's intuitive user interface further enhances the user experience, making it straightforward for providers to navigate the credentialing process, generate NCQA-compliant credentialing files, and expedite committee workflows through automation.

Dashevsky’s Dissection

As a physician in this wildly complex healthcare ecosystem, I've seen the pivotal role that efficient credentialing plays in our profession. It's not just about ticking boxes but rather ensuring we can deliver care to those who need it most without unnecessary delays.

Medallion stands out for their efficiency and effectiveness—and you should know by now that I’m a huge fan of efficiency and effectiveness. While some competitors tout "insta-credentialing," they often focus narrowly on primary source verification. Medallion, however, encompasses the entire credentialing journey, from initial data collection to the creation of the credentialing file, ensuring unparalleled accuracy throughout.

From a financial perspective, Medallion's value is clear. Traditional credentialing is costly, potentially exceeding $20,000 per physician annually when considering the hourly rates for credentialing work, additional office staff costs, and the indirect costs associated with delays (e.g., lost revenue from time that could be spent with patients). Medallion's solution offers a clear financial return on investment by streamlining credentialing, leading to faster reimbursement, better revenue cycle management, and stronger payer relationships. This efficiency not only saves direct costs but also reduces the opportunity costs associated with lengthy credentialing processes.

From a system perspective, the importance of credentialing automation is increasingly recognized, with the market projected to grow from $2.63 billion to $6.47 billion by 2032. Yet, inefficient credentialing can lead to compliance issues, scalability challenges, and cash flow disruptions. Medallion's platform, designed for scalability, manages over 40,000 providers and handles more than 91,000 licenses, enrollments, and credentials, showcasing its capability to support healthcare entities as they grow and evolve.

In summary, for any healthcare provider or organization seeking to optimize their operations, reduce costs, and focus more on patient care, Medallion represents a strategic and financially prudent choice. Its comprehensive approach to credentialing stands unmatched in terms of efficiency, accuracy, and scalability, making it an invaluable tool in today's fast-paced healthcare environment.