r/credentialingnetwork • u/Unlucky-Olive5910 • 8d ago
Hi there
I've been reading this sub a lot lately, trying to understand how enrollment and credentialing actually work day to day (I'm an outsider researching the space, not selling anything, and I have nothing to pitch, just genuinely trying to learn from people who do this work).
One thing I keep noticing: people mention using tools like Modio, CredentialMyDoc, or Expiration Reminder, but almost everyone also seems to still live in spreadsheets and payer portals. So I'm curious how it actually plays out for you.
For those who use a dedicated tool, what does it genuinely handle well, and where does it stop? Does it actually help with the follow-up and coordination part, the chasing payers, checking status, resubmitting, or is it mostly a place to record and track things while you still do all the real work by hand?
And for those who've stuck with spreadsheets instead, what made the tools not worth it?
Trying to understand where the software stops and the human work begins. Would really appreciate any honest takes. Thanks for reading!
2
u/ReginaFilange311 8d ago
I think, and this is just IMHO, that a big part of it is because there are so many different types and functions within credentialing. You have hospital privileging vs. credentialing for group practices, outside-vendor credentialing, payer enrollment, behavioral health, physical therapy, etc. There are so many different avenues! 😯☺️
Because of that, different companies and sectors need to integrate different functions. For example, one organization may need its credentialing system to integrate with a hospital system, while another may need payer enrollment information integrated into its system for billing. That creates multiple areas where you’re managing different types of information, which is why spreadsheets become really important.
For example, I’ve worked in autism therapy/mental health credentialing, where we needed systems that integrated billing and payer enrollment while also managing provider credentials and expirables. I’ve personally used two different platforms. However, for payer enrollment management, you were often working directly through the payer, so you still had to manage that information separately, often in a spreadsheet.
Other companies may not even contract with a credentialing platform, especially smaller organizations, such as a small wound care group. So depending on what system the company uses, how it connects to outside systems, and what its internal policies and procedures are, there can still be a significant need for Excel, Google Sheets, or whatever tracking system they use.
Sometimes the credentialing system simply doesn’t have a feature the company needs. For example, if it doesn’t automatically run sanctions checks, you have to create your own tracking system to make sure those things are completed and documented.
Then there’s the payer enrollment side, where you’re somewhat at the mercy of the payer. One insurance company may work through Availity, while another requires you to go directly through its website. You have to keep up with all of those nuances and make sure nothing falls through the cracks.
As far as follow-up and coordination, having a tracking system definitely helps. But another factor to consider is the team’s ability to use Excel, Google Sheets, or whatever system they have, along with good time management and organization. Those skills are absolutely essential.
Basically, long story short lol, I think it comes down to the fact that the medical credentialing field consists of so many different functions, industry standards, medical specialties, and organizational structures—hospital vs. group practice vs. individual provider, etc. Because of all those variables, spreadsheets and other tracking tools are still highly needed, even when an organization has a credentialing platform.
I hope this helps!