Five Ways AI Automates Provider Credentialing

But beyond the financial impact, delays also put barriers in front of access to care. Lengthy credentialing times mean healthcare organizations struggle to staff their facilities, creating gaps in care that can hurt patient outcomes.

Enter artificial intelligence, the buzziest of buzzwords. More and more leaders are experiencing general weariness around it in a condition called "AI Fatigue". While AI has become a cliche, it's not just hype when it comes to physician credentialing. Leading hospitals and organizations are already implementing AI into their physician credentialing software to slash processing times, improve accuracy, and enhance provider satisfaction.

Here are five ways enterprise healthcare organizations are using AI to make their credentialing process better.

Improving Credentialing with AI

1. Document Processing

Given the paperwork involved, it's no wonder that credentialing takes 120 days on average. It starts with physicians submitting a mountain of documents, including resumes, CVs, diplomas, certifications, and licenses. They're not the same formats, either. File types include PDFs, faxes, and emails. Credentialing specialists end up sifting through these documents, often re-entering data. It's a time-consuming, error-prone, and exhausting process.

AI-powered Intelligent Document Processing (IDP) is changing that.

Using natural language processing, AI tools can analyze and extract key information from countless formats with incredible precision. Whether a document is a scanned fax or a neatly typed PDF, IDP applies a consistent process to extract critical details. From there, workflow automation directly maps data into structured formats within a central database.

The result? No more manual data entry, no more hunting for missing documents, and no more wasted hours. Credentialing teams can move faster while maintaining data accuracy.

2. AI Primary Source Verification

Primary source verification—checking the authenticity of a provider's credentials with issuing authorities—is arguably the most tedious step in the credentialing process. It involves multiple systems, phone calls, emails...and that's just the beginning.

AI takes this burden off your team's shoulders. Advanced AI platforms integrate directly with over 3,200 primary sources, including SAM.gov, the National Provider Identifier (NPI) database, and drug enforcement agencies like the DEA. AI can instantly match the provider's submitted data to these sources, verifying identities, certifications, and professional licenses in seconds.

And with the right configuration, AI can continue to monitor physician credentials after verification. Expirations, suspensions, or status changes are flagged to ensure ongoing compliance.

3. Care Gap Analysis

Credentialing isn't just about making sure providers are qualified. It's also about ensuring their qualifications meet patient's needs. That's where AI-powered care gap analysis comes in, giving credentialing teams deep insights into staffing inadequacies and predicting future needs.

By analyzing large datasets, AI identifies gaps across several key areas:

• Geographic Regions: Pinpoint underserved communities and find physicians ready to fill the void.
• Shift Availability: Identify gaps in night shift, weekend, or on-call coverage.
• Telehealth Readiness: Discover providers who are equipped to offer virtual appointments, a critical part of today's hybrid care environment.
• Specialty Certifications: Quickly track down physicians with niche certifications like neonatal resuscitation or advanced cardiovascular life support.

Predictive AI ensures healthcare organizations meet demand without geographic or specialty blindspots.

4. Fraud Detection

Fraud is an unfortunate reality in credentialing. From falsifying documents to claiming credentials that don't exist, bad actors pose financial and reputational risks to healthcare organizations. Traditional compliance teams can only do so much to detect fraud, particularly when workloads increase.

AI combats fraud with a persistence that human effort can't match:

• Pattern recognition detects suspicious gaps, mismatched dates, or odd inconsistencies in physician resumes.
• Anomaly detection automatically flags deviations in documentation or credentials.
• Behavioral analysis tracks whether credentials have been referenced by multiple applicants.
• Natural language processing uncovers exaggerated claims in written documentation, spotting grammatical oddities or vague descriptions that may indicate falsehoods.

AI doesn't stop at detection. It goes one step further by assigning risk scores to flagged applications. Credentialing specialists can focus on high-risk applications, ensuring resources are used efficiently and fraud doesn't slip through the cracks.

5. Assistive Agents

Despite what you've seen from a few hot takes on LinkedIn, SaaS isn't dead...but it is evolving. Today's SaaS tools are shifting away from manual navigation and menu clicking towards telling it what you want it to do. These AI-powered helpers take on the grunt work and free your time for higher-value tasks.

Here's what that looks like for credentialing:

• Instead of manually configuring care gap analysis reports, specialists simply type, "What are the underserved areas for cardiovascular care in our network?"
• Need to know the status of an application? Just ask, "What's the progress on Dr. Smith's application?"
• Do you want to schedule follow-ups for expiring licenses? The assistive agent auto-generates those reminders for you.

Assistive agents handle repetitive administrative tasks so that credentialing teams can focus on getting qualified physicians in front of patients. The result? Faster credentialing, less burnout, and a quicker onboarding process for providers.

Making Credentialing Smarter...and Faster...with AI

AI is making credentialing faster than ever. It combines speed and accuracy in every step by automating repetitive tasks, integrating verification, and providing actionable insights.

The best part? These tools don't just save time and money — they reconnect your team to work they're passionate about, like ensuring patients' highest standard of care. Isn't that why we're all here?

Take the AI Step in Your Credentialing Process

If you're ready to get past a slow credentialing process, it's time to consider how AI could help out. Need help getting started? We'll help you identify gaps, implement solutions, and partner with you every step of the way in a free consultation.