BroadPath Blog

March 22, 2023 by Carol Verderese

End of PHE Could Cause Some to Rush Painstaking Credentialing Processes

Credentialing Crunch as PHE Expires

The announcement by the Department of Health and Human Services (HHS) that the COVID-19 public health emergency (PHE) will end on May 11th signals a return to normal for providers and payers required to verify the professional records that qualify a clinician to practice medicine. This formal process, known as credentialing, was relaxed under the PHE so that hospitals and providers could focus on treating patients during the pandemic. CMS warned, however, that those still relying on PHE waivers should catch up on documentation and other compliance operations posthaste.

The Devilā€™s in the Details

The expiration of the PHE has repercussions for providers given the administrative burden of updating and verifying information to meet credentialing requirements. This information includes board certifications, hospital admitting privileges, education, malpractice insurance, professional references, work history, and more.

Medicare Administrative Contractors (MACs), the intermediaries between providers and CMS in handling reimbursements, face similar administrative hurdles. Staff must research the background, education, licensure, and professional certifications of each applicant, often requiring primary source verification.

Bottlenecks occur for many reasons. One is that the size of some payer organizations can make expediting an application impractical. Another is that 85 percent of all credentialing applications contain missing, inaccurate, or out-of-date informationā€”possibly leading to delays in claim reimbursement, fines or penalties, accreditation problems, and even harm to patients if healthcare providers are unqualified.

Making matters worse, providers enrolling in payer networks spread across multiple states must be credentialed in each one where they deliver care. The states may have different credentialing protocols and re-credentialing timelines.


Get It Right the First Time

Credentialing is a highly regulated, labor-intensive, and time-consuming process, often taking up to six months to complete. At BroadPath, we appreciate that just one expired certification, missing document, or administrative oversight can result in delays in providing care or worse. Our PECOS-savvy talent community is versed in the shifting intricacies of credentialing and can implement strategies for meeting the demands of any application process, particularly during this transition period when speed to proficiency is critical. To learn more about us, please visit our website