Credentialing services

 

Medical credentialing: What is it?

The process by which healthcare organizations evaluate & approve doctors and other practitioners to deliver care inside their networks is known as medical credentialing. Credentialing is a crucial safety feature of the healthcare system because it confirms whether a doctor is actually licensed to practice.

Since insurance and medical billing agencies would only pay claims from licensed physicians, credentialing might also be seen as the initial stage of the revenue cycle management process.

Typically, a credentialing application needs:

·         Complete academic records and transcripts

·         Extensive work history

·         DEA registration, current medical license, and board certification

·         current records of one's medical history and vaccinations

·         evidence of ongoing malpractice protection

·         references, both personal and professional

·         complete explanation of any historical gaps or other anomalies

The Work of Credentialing Services

To ensure that the credentialing services goes as smoothly as possible, a credentialing service organizes & administers credentialing applications for physicians and other stakeholders.

Credentialing services are typically more positioned than physicians or their staff to address any delays or problems in a timely manner because they have in-depth understanding of the credentialing process and because they are not preoccupied with other activities. Ideally, this implies that the credentialing process takes less time overall, costs less money, and—perhaps most importantly—allows the doctor to start invoicing for services sooner.

Three key areas of services are typically offered by credentialing services to practitioners:

·         assistance for initial credentialing

·         Re-certification services

·         administration of "expiable"

Depending on where you are in your practice and career, your personal certification requirements may change. Credentialing is undoubtedly a crucial step in starting a practice, and if you're just getting started, you'll also be submitting your first applications for credentialing. If you have been practicing for a while, maintenance and renewals will constitute the majority of your needs.

SERVICES FOR ORIGINAL CREDENTIALING

The initial credentialing procedure will need to be completed by providers who have not yet received credentials from a particular entity. This might happen if you:

·         first graduates from college and starts working

·         A new state or nation move

·         switching jobs frequently

·         change careers to private practice

·         Establish a new practice

·         Would like to accept new insurance from patients

SERVICES FOR RE-CREDENTIALING

Each provider is periodically examined as part of the "re-credentialing" process to make sure they are still certified and able to practice inside a certain network. A "re-credentialing" or credential maintenance service's goal is to make sure this renewal procedure runs without a hitch. The process of re-credentialing need to be simple from the provider's standpoint. You can know very little about the re-credentialing procedure, unlike initial credentialing. This is crucial since you will be working and providing care for patients during this procedure, making it highly likely that any problems with re-credentialing may impair your capacity to do so.

Re-credentialing is frequently simpler because many aspects of the first application, such as education and employment history, remain constant and do not require revision. Many other aspects of a provider's application, however, are subject to alter and are examined with the same care as during the first credentialing process. These consist of:

 

·         Licenses, certifications, attestations, and other documents that must be used by a certain date (sometimes known as "expiable")

·         Work Experience

·         Examining any malpractice allegations or other problems

 

Re-credentialing requires the management of "expiable," although this is separate from the actual re-credentialing procedure. So, as a separate service, some businesses provide "expiable management."

CREDEN
TIALING FOR HOSPITAL

A doctor can only see patients inside a hospital that has granted him or her credentials to do so. While not an easy procedure, staff physicians do have institutional support in their credentialing. Physicians who work as staff at a hospital will address credentialing through their company.

The credentialing procedure must be completed individually, with little assistance from the hospital itself, for doctors who want affiliate status at a certain hospital. Independent doctors are typically required to include one or more additional medical professionals who could offer their patients backup care. Obviously, these substitute doctors must already have credentials from that facility. The applicant may request a reference from a doctor who is designated as a backup.