Nearly 50% of Healthcare Organizations Report Revenue Impacts Due to Unoptimized Workflows & Slow Turnaround Times

Staff Report From Georgia CEO

Tuesday, April 30th, 2024

Medallion, the leader in end-to-end credentialing and provider network management solutions, today released the 2024 State of Payer Enrollment and Credentialing Report. Medallion surveyed 337 provider-based healthcare organizations across the U.S. to explore and quantify their payer enrollment and credentialing workflows and the impact staffing challenges, budget restraints, and turnover have on these workflows.

As healthcare organizations face extreme pressure to get providers in network with insurance payers and see patients faster, the report offers a detailed view into the most painful and time-intensive payer enrollment and credentialing processes.

"Our mission at Medallion is to free healthcare teams to focus on what matters," said Derek Lo, CEO and founder of Medallion. "This report dives into how much time is spent on administrative tasks rather than patient care. It also highlights the collective optimism and support our industry has for technology solutions that help speed up these processes and eliminate wasteful tasks. We hope the findings within our '2024 State of Payer Enrollment and Credentialing Report'  help healthcare organizations see the impact they can have on efficiency and ultimately patient outcomes by implementing more effective solutions for back office administration."

Below are five key findings for the 2024 State of Payer Enrollment and Credentialing Report:

52% of respondents reported entirely manual credentialing workflows

Credentialing is a mission-critical function that ensures providers are who they say they are and have no sanctions against them. However, relying on manual processes to tackle everything — from provider data collection, application receipt, credential file creation, review, primary source data verification, committee evaluations and approvals — requires too many administrative hours and results in revenue leakage and compliance issues.

46% of respondents reported revenue impacts to their healthcare organization due to unoptimized enrollment workflows and slow turnaround times

While payer enrollment turnaround times are indebted to insurance payers' quickness, unoptimized enrollment workflows and slow turnaround times from onboarding to application submission result in costly delays for healthcare organizations.

Nearly 40% of healthcare professionals reported moderate reliance on manual processes in their payer enrollment workflows

Beyond that, 69% of respondents rely on two or more software tools to complete enrollment. When you combine moderate reliance on manual processes and multiple software tools, it's no wonder healthcare teams are plagued with inefficient and unoptimized workflows, leading to long-term impact on an organization's bottom line.

57% of healthcare organizations experienced turnover and staffing challenges over the past year

The report reveals that the turnover rate among enrollment and credentialing teams is significantly higher than other healthcare professionals, signaling a critical stress point within healthcare operations and directly impacting the speed at which providers can get in-network, see patients, and ultimately generate revenue for the organization.

Around 60% of respondents spend more than half a business day on primary source verifications

Primary source verifications are a single step in the multi-step credentialing process. With nearly 60% of respondents spending more than four hours on primary source verifications for a single provider, it's no wonder the end-to-end turnaround time for almost one-third of respondents is 30+ days.

To uncover more findings and what comes next for healthcare organizations, read the full 2024 State of Payer Enrollment and Credentialing Report. To learn more about Medallion, visit the website.