A sizeable part of the credentialing and enrollment industry’s efforts to go paperless hinge on electronic signatures (e-signatures). After all, the act of signing on the dotted line is what gets your “paperwork” over the goal line.

But e-signature’s use hasn’t reached saturation in medical credentialing, privileging, or enrollment. There remain payers, hospitals, and other healthcare entities with policies mandating a “wet” signature, which is a physical mark on a hardcopy document created by a person. Note that wet web signatures also exist, usually located in an editable document with a space for the signatory to type their name.


What’s holding the field back from 100% use of e-signature?

Confusion over what’s acceptable by law and by regulators and accreditors, misinformation about security of the technology, and muddled definitions of industry terms contribute to e-signature’s slow adoption.

The law supports e-signature’s use

The legality of e-signatures is sound at state and federal levels. In 1999, the Uniform Electronic Transactions Act (UETA) was introduced and subsequently adopted by 47 U.S. states, the District of Columbia, and the U.S. Virgin Islands. UETA states that when a law requires a signature, an electronic record or an electronic signature is acceptable when the parties to the transaction have agreed to proceed electronically.

Then in 2000, the federal ESIGN Act was passed granting legal recognition to electronic signatures and records if all parties to a contract choose to use electronic documents and to sign them  electronically. Both electronic and digital signatures are legally binding.

The accreditors/regulators are on board

NCQA standards allow for digital and electronic signatures. Signature stamps are not acceptable to NCQA unless the practitioner has a physical impairment and the disability is documented in the credentials file. URAC standards allow for electronic and digital signatures. Written policies and procedures should establish controls and manage risk for electronic signatures.

The Joint Commission, DNV GL, AAAHC, and CMS COPs standards and regulations for hospitals do not specifically address e-signatures on applications. TJC standards require a reliable and consistent process be in place to process applications. Since the standards and regulations of these regulatory bodies don’t specifically prohibit e-signature use on applications and attestations, hospitals are free to decide if they wish to use such a process.

The technology’s long been in place

The technological ability to embed digital signatures into PDF documents has been around since 1999. And many medical credentialing software programs allow for e-signature, whether for contracts, forms, letters, certificates, or other official documentation. However, beware that some technology referred to as “e-sign” is not the same as e-signature. Nor is copying and pasting an image of a signature into a document then creating a PDF considered e-signature.

And while you need a scanner to go paperless, you shouldn’t need one to fully employ e-signatures. To fulfill your organization’s goal to truly become paperless, it must be electronic for both the applicant and the requestor—and the documentation remains in the database or in emails between parties. In other words, you can’t claim e-signature ability if the application, or even just the signature page(s) must be printed, signed, and scanned back into the software.

Well-established third-party vendors such as DocuSign, AssureSign, RightSignature, and others have collaborated with credentialing software companies that have embedded the technology in their solutions, so those programs can boast true e-signature capability. True e-signature, therefore, electronically binds the signature to the document, requires authentication of the signer’s identity, and doesn’t allow for the signature to be altered after it’s imprinted on the document.


What happens when a payer doesn’t accept e-signatures? Hospitals and healthcare organizations can only keep up the pressure on payers to allow e-signatures. And multiple states (AZ, KY, ME, NM, NY, RI) are indirectly aiding the inevitable progress toward e-signatures by passing laws that require specific turnaround times by insurance companies and Medicaid for credentialing and enrolling a provider. The prevailing thought is that once the onus is on the payers to speed the process, the insurers will look to tighten any lag in the system. That might just be found in the time it takes to use e-signature rather than circulate a hard copy to providers.