There's no denying the benefits AI offers in billing and credentialing for healthcare providers. It can help with cutting timelines, automating document checks, and flagging expirations. While AI is making great advancements, it still cannot achieve the level of accuracy that human-led medical credentialing services can. One mistake could end up costing your practice much-needed profits and even putting your ability to provide care at risk.
The Best Outcomes Come from Thorough Medical Credentialing Services
Here are 6 reasons why you shouldn't commit to fully automated credential services and instead trust experienced professionals.
1. AI is only as Good as the Data it's Fed
AI must be trained on already created documents and materials. If there is an error in any of these, the AI will internalize and repeat the same mistakes. Providers are busy, and fragmented and inconsistent data is understandable. With years of siloed data and manual processes, even advanced AI programs will struggle to sort this.
A credentialing company organizes and checks the data for you, ensuring the correctness to build a strong foundation for future automation.
2. AI cannot Perform True Primary Source Verification (PSV)
Primary source verification (PSV) means confirming credentials directly with the issuing institution: the medical school, the licensing board, or the malpractice carrier. AI can cross-reference databases, but it cannot contact a board that hasn't updated its digital records, resolve a discrepancy in a foreign-trained provider's history, or follow up on a faxed document. Credentialing teams must continue using primary source verification because AI cannot fully replace this step.
3. Multi-State Complexity Is Too Dynamic for AI to Track Alone
Certain providers, like telehealth practitioners and physical therapy groups, can practice across state lines, and the rules governing where and how they can do so change constantly. Interstate compacts such as the PT Compact and the Interstate Medical Licensure Compact (IMLC) allow providers a more streamlined licensing across state lines, but Medicaid programs vary radically by state. AI can assist with accelerated credentialing, but interpreting which rules apply to a specific place and how they're shifting requires a specialist who follows regulatory updates daily.
4. AI Hallucinates, and in Credentialing That's Dangerous
Hallucination—when AI generates factually wrong information and confidently presents it as accurate—is a documented, recurring behavior. AI tools can generate distorted or inaccurate information, including recording events that never occurred or omitting critical details. A hallucinated board certification or missed sanctions can result in a provider delivering care despite not having the accurate credentials and licenses. AI risks, including model degradation and monitoring failures, can expose providers to liability under the False Claims Act.
5. AI Can't Explain Its Decisions
When a credentialing decision is challenged, providers must explain exactly how it was made. Many AI models operate as "black boxes", making decisions difficult to explain and fundamentally undermining accountability and regulatory defensibility. When medical credentialing services are managed by human-led teams, providers can escalate issues to experienced decision-makers. Today's AI-heavy processes often offer no such pathway.
6. Accountability cannot Be Delegated to an Algorithm
In 1979, IMB added the phrase “A computer can never be held accountable, therefore a computer must never make a management decision” to their training manual, and it applies more than ever to current AI. Someone must own the consequences of a credentialing decision, and that cannot be software. A human credentialing professional will always provide final verification and approval to ensure accuracy and adherence to standards. Meaningful oversight means a human has the final say and can genuinely investigate rather than rubber-stamp AI output.
Medical Credentialing Services You Can Rely on Completely
At Altruis, we utilize modern technology and advancements like AI where it makes sense, but we keep the human touch that medical providers need to ensure their credentialing and enrollment are executed correctly. With over 20 years of experience, our team of highly trained healthcare and technology professionals reduces errors, improves efficiency, creates and maintains CAQH profiles, verifies that all state-to-state compliance is met, and more.
Let's work together to ease your administrative burdens and maximize your revenue potential, the right way.Get started with a free billing assessment.
