The Case for a “Single Source of Truth” in Provider Credentialing

Provider credentialing is a necessary task that ensures physicians are qualified to deliver patient care and receive compensation. It impacts not only the providers’ ability to work, but also patient safety and access to care. While we’ve seen some big advancements in credentialing over the past decade such as automating credentialing workflows, there is still no “single source of truth” for credentialing data. Having this could be a game-changer.

A single source of truth for provider credentialing would involve creating a centralized, continuously updated database of credentialing information that could be accessed and trusted across the healthcare sector. While no such system exists today, it should be the goal, and here’s why. 

The credentialing challenge

Credentialing is a complex process that involves multiple steps to verify a provider’s qualifications. This includes the provider’s education, licensure, certifications, and clinical experience, among other documentation. Where things can get frustrating is that these steps are often repeated multiple times if the provider wants to work at different hospitals, with separate payers, not to mention in more than one state — the same data has to be submitted repeatedly, causing delays for providers. 

For example, consider a physician working as a locum tenens, a temporary role used to fill gaps in care. The very nature of locum tenens usually requires physicians to work in different states at various hospitals and health systems, often within short time frames. These physicians often need to provide the same documentation at each new facility, even if they have been credentialed elsewhere recently. 

Because many hospitals and health systems don’t use modernized credentialing systems, it can take anywhere from 90 to 120 days, delaying physicians from starting their work and getting paid and limiting patient access to care. For a physician credentialed in multiple hospitals or health systems, such as a locum tenens or for someone practicing telemedicine across state lines, these repeated verification processes can become a significant time and cost burden.

Building a single source of truth

A single source of truth for provider credentialing would shift this dynamic. If the necessary data could be pulled from nationally recognized, verified sources — medical schools, previous employers, licensing boards, and so forth — and stored in one centralized system, there would be no need for the constant, repetitive verifications, endless paperwork, and waste of time for providers and credentialers.

Imagine a reality where a provider’s credentialing profile is maintained in real time. If new information becomes available, such as a license renewal, it would automatically be updated. A single source of truth credentialing model would make this process cohesive and efficient for hospitals, payers, and other organizations, not only reducing the need for redundant checks, but also helping minimize delays in getting providers to work.

Of course, for a system like this to work, trust is key. Standardization of data would go a long way to establishing trust, as would partnerships with organizations such as the National Committee for Quality Assurance and The Joint Commission that can help to ensure data integrity. 

Overcoming barriers to data sharing

There are areas where progress is being made to simplify credentialing such as through the  Interstate Medical Licensure Compact (IMLC), an agreement created to streamline traditional medical licensing processes and take the burden off providers who want to practice in other states. While the IMLC has grown over the years, it’s not a silver bullet solution. 

A centralized credentialing model could support the IMLC by providing a standardized set of data points that individual states could access when credentialing providers. This would make it more streamlined and quicker for providers to practice across state lines, enabling them to start practicing when and where they are needed most.

Interoperability also is a significant hurdle in healthcare as a whole but especially for credentialing. In the credentialing world, data sharing is challenging due to the lack of a common language for describing credentials and widespread mistrust of external data sources. Until a standard format is adopted and respected across the sector, organizations will continue to repeat the same verification processes independently.

To facilitate data sharing, the healthcare industry needs to adopt modern technological solutions like APIs and secure data exchange protocols. APIs could enable automated, real-time updates to a centralized credentialing system, allowing for timely and accurate data flow. In turn, healthcare organizations would spend less time gathering and verifying credentials and more time delivering patient care.

The road ahead

With the growing popularity of alternative practice models like telemedicine and locum tenens work, physicians need more flexibility. A single source of truth for credentialing would make it easier for providers to practice where they are needed, with fewer unnecessary delays or roadblocks.

Credentialing may not be the most hot button issue in healthcare, but it is one of the most necessary and important processes. In the coming years, expect to see more conversations about centralizing credentialing data and implementing continuous credentialing models. By laying the foundation for a single source of truth now, we can simplify credentialing, reduce administrative burdens, and help alleviate physician burnout — ultimately supporting better patient care down the road.

Photo: nespix, Getty Images

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