Credentialing is particularly important for physicians regarding practice establishment and payment from insurance plans and other third-party payers. However, the current credentialing process is complex, time-consuming and costly. Blockchain in healthcare credentialing is an innovative technology solution that could reduce time and costs. What is credentialing on the blockchain, and what are its specifics? Now, let’s take a closer look at the current credentialing method and how it could be done better through blockchain.
Current Method of Professional Credentialing
Healthcare institutions must create safe environments and provide quality patient care services. To this end, facilities must be able to verify staff competency. Credentialing proves that the healthcare facilities’ personnel are qualified to deliver direct patient care in their capacity. Documentation verification could include state licenses, DEA licenses, board certifications, education, required training, hospital linkages, and malpractice coverage. This procedure includes telephoning various firms to verify the information. To offer care independently, healthcare personnel that fall under the jurisdiction of a licensing body have to be accredited. Most practitioners are deployable in various healthcare facilities and require validation in these areas, hence facing a lot of overlap.
The NCQA is responsible for verifying the credentials through a Credentials Verification Organization (CVO) by using the verification of the diploma and degree with the source. National Practitioner Data Bank, a U.S. Department of Health & Human Services program, is a web-based repository of reports covering medical malpractice payments and adverse health practitioner, provider, or supplier disciplinary or corrective actions. The ABMS recognizes 150 medical subfields, whereas the AANP and the ANCC authenticate the eligibility for nurse board certification.
What is Blockchain Technology?
It is a technology that decentralizes an organization’s data and stores it on thousands of servers so that users on a particular network can view entries in real time. This supports the establishment of communication networks that may help share healthcare data.
Blockchain is a public electronic ledger that can be freely distributed among users to create an immovable record of transactions, with timestamps and links to the previous transaction. Each series of transactions is another link in the chain with a secure code to the next link. Persons would be allowed in; once records are fed into the system, they cannot be deleted. Indeed, it is impossible to hack the blockchain because tweaking this data system requires access to every computer in the system.
Blockchain Credentialing: How It Works
Some healthcare institutions are currently experimenting with blockchain in healthcare credentialing. The conventional procedure is expensive and time-consuming, may last from four to six months, and causes losses of earnings and reimbursements. An organization’s current healthcare provider data could efficiently be obtained through blockchain technology. The Council for Affordable Quality Healthcare stated that payers spend $1.9 billion on maintaining provider lists (American Hospital Association, 2019). It is believed that if one source, such as blockchain, is used and verified, the cost will be considerably reduced.
How would healthcare in credentialing work?
Provider credentialing:
- The provider/health professional uploads background information such as educational history, certifications, licenses, malpractice insurance, and other documents to the blockchain.
- Primary sources access the blockchain and verify the provider’s information.
- Health facilities check provider data on the blockchain using primary source verification and either accept or reject the provider, then upload the decision/result to the blockchain.
Payer credentialing:
- The enrollment application is sent to the payers if the provider is accepted.
- Payers verify data in the blockchain using primary source verification and either accept or reject the application, then upload the result to the blockchain.
- Patients may verify the provider credentials and credibility using blockchain.
- Government regulators audit provider credentialing processes.
Future Prospects of Blockchain in Healthcare Credentialing
There are plenty of possibilities for using blockchain in the future of healthcare credentialing. Consistent with the findings from this study, more pilot programs are expected to show that this technology works and, thus, is adopted. Many business sectors might adopt Blockchain as a credentialing method, making it an effective, secure and cheaper form of activity. Also, improvements in the part of the blockchain and its compatibility with other healthcare systems can improve its usefulness and implementation.
Conclusion
Blockchain technology can transform the current credentialing process in healthcare facilities into a highly efficient, secure, and relatively inexpensive process. Nevertheless, as we have seen, some challenges must be addressed, yet the advantages of blockchain credentialing are compelling enough to make it an avenue for the future. With the healthcare industry fully embracing new technologies for its operations, blockchain technology could be important in ensuring that healthcare providers are accredited efficiently.
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