Cost of Poor Quality from Inadequate Credentialing and Privileging

$100,000–$1,000,000+ per major adverse workers comp quality event, including malpractice, legal disputes with employers/insurers, lost contracts, and damage to the center’s reputation as a safe work‑injury provider. • $100,000–$1,000,000+ per major quality incident involving employer‑plan members, including malpractice, damage to employer relationships, termination or downsizing of contracts, and loss of future employer business. • $100,000–$1,000,000+ per serious quality event in malpractice payouts, legal defense, internal investigation and peer review time, additional training and remediation, lost productivity from suspensions or replacing the provider, plus reputational damage and potential payer/network consequences; even one missed credentialing or privileging failure every 1–3 years can average $50,000–$300,000 per year in expected loss across the outpatient network.

Compliance assembles provider packets for employers and TPAs manually, pulling from scattered sources and relying on narrative explanations rather than standardized risk scoring and dashboards. • Compliance cobbles together credentialing evidence and quality signals from emails, shared drives, paper files, HR systems, payer portals, and ad‑hoc spreadsheets instead of a unified credentialing and performance risk platform. • Compliance mirrors hospital‑style credentialing with manual spreadsheets, email chains, and shared folders to track verifications, peer references, claims history, and performance evaluations.