With the U.S. healthcare sector spending over $800 billion1 annually on administrative costs, achieving operational efficiency across enrollment and credentialing is crucial for financial sustainability.
This year, the industry has faced climbing pressure to get providers in network with insurance payers and see patients faster. And, according to Medallion’s 2024 State of Payer Enrollment and Credentialing Report, 46% of healthcare professionals say they have seen revenue impacts due to these unoptimized workflows and slow turnaround times within their organization2.
Compounded by high turnover and low staffing levels in enrollment and credentialing teams, healthcare organizations face a situation that underscores the urgency for leveraging the right technology to enhance efficiency and ultimately increase more widespread access to patient care.
Automation: A fundamental shift to elevate operations teams’ work
While payer enrollment and credentialing are critical for quality and safety, a substantial portion of teams struggle with manual, inefficient processes — and their repercussions:
- 30% of payer enrollment teams say gathering requirements from providers is the most significant challenge yet 40% say their workflows are mostly manual. The long timelines for payers to process claims and remit reimbursements — often stretch between 90 to 120 days — due to these slow, manual workflows.
- In credentialing, roughly a quarter of teams report gathering requirements from health plans is their most significant challenge, yet 52% of teams say their workflows are entirely manual — from collecting information and documents related to the provider from various sources, including a provider's education, license, work history, National Provider Identification (NPI) number, fellowships, liability coverage, eligibility for state regulatory requirements and board certifications, and more.
- And in credentialing, 84% of these teams experience end-to-end turnaround times of 15 days or more. In credentialing, manual workflows not only strain resources but also delay healthcare delivery, impacting both patient care and organizational revenue.
The increasing demand for healthcare services, coupled with a limited provider supply3, places organizations at a critical juncture. Simplifying and automating these processes could greatly enhance operational efficiency and care quality.
A strategic response to staffing and operational challenges
The healthcare industry has consistently faced staffing challenges characterized by long hours, competitive pay and erratic work schedules. With many enrollment and credentialing teams being asked to “do more with less,” the pandemic further amplified these issues, resulting in turnover rates in 2022 that ranged from 19.5% at hospitals to 65% for at-home care providers4.
Such turnover - and the consequences that come with it - pose financial and logistical hurdles for healthcare organizations and impact the capacity to manage increasing outpatient demands.
Despite these challenges, optimism for workflow automation is high among healthcare professionals, with 53% of teams prioritizing it to simplify routine tasks this year The potential of automation and AI to transform healthcare delivery, while still valuing human oversight for complex decisions, is clear, promising a more efficient and responsive system.
To work smarter with automation, healthcare organizations can find immediate success in three key areas:
- Reducing reliance on manual processes with solutions that streamline enrollment and credentialing, saving time and resources.
- Addressing variability and delays using automation to standardize processes to achieve consistent and efficient outcomes.
- Creating seamless workflows that increase revenue opportunities and enhance operational efficiency.
Yet, the response to this challenge must be as dynamic as the environment we operate in — rooted in leveraging automation and AI to streamline workflows and catalyze a broader transformation in healthcare delivery.
The time for leaders to act is now. Embracing automation and AI is about envisioning a future of healthcare where technology and innovation lead to enhanced access, efficiency and compassion in care delivery.
Downloading the report provides insights necessary for leading this transformation. Get it all here.
- https://www.acpjournals.org/doi/abs/10.7326/m19-2818
- Medallion’s 2024 State of Payer Enrollment and Credentialing Report, https://medallion.co/resources/ebooks/the-2024-state-of-payer-enrollment-and-credentialing
- https://www.fiercehealthcare.com/providers/demand-behavioral-health-services-outstrips-supply-providers-driving-higher-costs
- https://www.oracle.com/human-capital-management/cost-employee-turnover-healthcare