KLAS Rates Provider Credentialing Solution Efficiency

Healthcare organizations have tapped vendors for provider credentialing solutions to increase efficiency, but not all companies are created equal, a new KLAS report suggests.

“Credentialing management has historically required dozens of spreadsheets, manual data entry, and painstaking monitoring of multiple payer, state, and national databases—causing significant inefficiencies and expenses,” the market research firm says in the “Credentialing 2022: What Solutions Have Fulfilled Their Efficiency Promise?” report.

“Vendors providing credentialing software and/or services promise major efficiency gains for healthcare organizations, but not all offerings are equally effective,” the report continues.

The report examines leading provider credentialing vendors—ASM, Modio Health, Qgenda, RLDatix, Silversheet, symplr, and VerityStream—to determine how successful their solutions are at creating efficiencies for end users. The report uses three “strong indicators” of solution efficiency: the use of automation, strong credentialing workflows, and vendor partnership/guidance.

ASM’s MD-Staff, Modio Health’s OneView, RLDatix’s Credentialing (Verge Health), and Qgenda’s Credentialing (CredentialGenie) all have a high impact of efficiency while also driving tangible outcomes, KLAS reports. Although, the firm had limited performance data on QGenda’s solution.

The report says that ASM and Modio are reducing turnaround times and can consolidate tracking to improve provider credentialing efficiency. Notably, ASM and Modio Health customers report the elimination of paper credentialing because of solution capabilities, such as virtual committee capabilities, connections to outside databases, and a single source of truth for credentialing data.

Customers would like to see better background checks and state licenses from ASM, as well as CAQH connection, better license verification, and expiration notifications from Modio Health.

Meanwhile, customers of RLDatix, which acquired Verge Health in 2020, enjoy the combination of software and services. Customers are not fully responsible for all credentialing tasks with RLDatix, but they generally praise the vendor’s front-end automation for credentialing panels and renewal notifications. The downsides of RLDatix include entity cloning and status tracking, according to the report.

Cactus/IntelliSoft from symplr, the only other vendor for which KLAS had enough performance data, is just under the market average for efficiency and tangible outcomes, according to the report.

Some symplr users complained about training resources, which they claim spurred them to create workarounds rather than configuring workflows to meet their needs. However, some users report seeing success with workflows after using the vendor’s support line and they say the solution is generally easy to use.

Generally, customers said Cactus’ document autofill and automatic license verification, as well as IntelliSoft’s expiration notifications and autorun reports drive efficiency.

symplr isn’t the only provider credentialing vendor struggling to create strong workflows for end users. The report finds that all the vendors are lacking some ability to configure workflows to increase efficiency. KLAS calls for industry-wide improvement to provider credentialing workflows.

As for the other vendors in the report, VerityStream and Silversheet rank below market average for impact on efficiency based on limited data. Although, Silversheet did drive some tangible outcomes based on customer input, while users say VerityStream drives few tangible outcomes.

Each provider credentialing solution had its pros and cons. However, the report adds that using automation for document filing, virtual committees, and license verification is a major benefit.

“Regardless of vendor, customer respondents who report using automations for document filling, virtual committees, and license verification are significantly more likely to report positive outcomes and say their vendor has improved their efficiency,” the report states. “Automations with room for improvement are also generally consistent across vendors; state-license verification, entity cloning, and status tracking are common pain points.”