How Credentialing Now Automates Medical Credentialing and Payer Pushes

The medical company I work for as an engineer received multiple emails from existing clients asking for help with credentialing. This shone a light on the need and potential market for this product. It's not a frustration that directly impacted me; it's a frustration that impacts our clients. That voiced concern started the process. I spent months talking with front offices, credentialers, owners, and speakers in the industry trying to fully understand the challenge they were grappling with. Only then did I start building what I believe is fast becoming the industry standard for digitalizing medical credentialing nationwide. Another piece that works hand in hand was that my dad (a dentist for 30+ years) worked for a corporation that was supposed to manage his DEA number. They didn't, and let it expire. This embarrassing oversight left him (the doctor) unable to prescribe meds for his patients. So I manage DEA numbers as well.

I initially bought a 'marketing package' that included social media marketing and a tech setup. I thought they would be doing the marketing for me (and for that price, they should have), but instead it was an education on how to do it myself. It was essentially doing B reels on Instagram. These social media reels did land a demo, but otherwise were a flop. No real traction. I've now started on some email marketing, no real response as of yet. I'm running this campaign through Go High Level's automations and set it up to do 4 rounds to a list of potential clinics and their owners. My hope is to find that a certain percentage answer and a percentage of these end up buying. That would give me some strong evidence moving forward that I could buy a larger list and then take that strategy into the larger market.

We don't have any real clients as of yet. Based on feedback I've gotten from demos, they want the ability to push to insurance portals, which is something I don't currently offer. I've heard this from four different clinic owners. They're looking for someone to take this completely off their plates, without complicating and without having to teach a current system. They complain about "not knowing" where the process stands. They wonder what would happen if the one person they had in charge of credentialing suddenly left (the bus factor) and how they'd be able to continue a process when they themselves don't have visibility into it. They also believe credentialing to be a completely manual process, meaning they'll have to make phone calls, take notes, send paperwork, and overall handle the process EVEN if the data management is fully handled. At this point, we've replaced their spreadsheets; now it's time to replace their labor.

I think people assume they can be the hero, when in reality each clinic owner views themselves as the hero and I can position as the guide and support system to help this hero fulfill his or her mission. People often think the number one thing that a clinic, hospital, or office might need is more patients. If that were the case, then they only need marketing to have a better practice. But without the right systems in place, more patients can bury these small providers. What we can give is the ability to grow. We bring a system that supports growth and enables them to put their time into the things that matter, the patients, their concerns, their fears, etc. Then, when you have systematized, you have the ability to grow and to continue to provide the very best service to your patients. This is our vision.

I am currently adding AI to the follow-up process. This will ensure that follow-ups to the insurances (payers) get handled without eating up a real person's time. A follow-up may consist of 30 minutes waiting on hold. This is silly for an intelligent person to do when AI can easily wait the 30 minutes and then collect data. The other thing we're doing is automating the push to insurance portal process. This is an enormous challenge for the industry, but one that we are excited to take on.

Well, 0 clients currently. I launched in June and am hopeful of getting my first clients in the next week or two.

I spent 6 years in medical software before launching my own company. This gave me extensive experience in how these companies work in their day-to-day operations. The types of clinicians they hire, the amount of time they'll take in learning and implementing a system, etc. I've even visited clients on-site to see how they work and to develop rapport with them. This really helps to change things from caring about 'software' to caring about people who drive it and their patients. This is how we change the industry and change the world one small piece at a time.

I assumed what people needed was a data management system (this is part of it), but the bigger piece they need is an automated follow-up and an automated push-to-payer system. This would alleviate most of the pressure on their team. Owners are looking for a way to save money, not just add a system. So the bigger lesson is to provide something that allows them to move human capital towards something else, towards money-making activities, not towards something that can be automated. This industry has historically been difficult to automate because of the payers, both individual portals and follow-ups. This is the problem to overcome.