In the healthcare sector, medical healthcare professionals need to be competent enough to bring quality medical services to the table. To achieve this objective, the process of medical credentialing is exercised. It is a process in which the verification of qualifications of healthcare professionals is carried out to achieve the deliverance of quality healthcare. Want to know more about it? Read further. This blog is all about what medical credentialing services are, its benefits, and why it is important for healthcare organizations.
What is Medical Credentialing?
Medical credentialing is a formal process in which the systematic verification of the qualifications of healthcare providers takes place to ensure professional integrity. It aims to guarantee that healthcare professionals meet the already established standards set by regulatory bodies and healthcare organizations. This process includes the verification of academic qualifications, house job training, and professional experience. Additionally, it includes the thorough conduct of background checks and references from the employees of the previous institutes and an investigation of the licenses and certifications the professionals hold.
Importance of Provider Credentialing
There are a plethora of benefits of provider credentialing, but the primary purpose is patients’ safety and quality of medical services. First, the security of patients is essential. The majority of the patients do not even know such a system exists. They; however, rely and trust on healthcare systems for their quality medical treatment. In this regard, the credentialing system works to prevent unqualified individuals from providing healthcare services; hence, ensuring patients’ safety. Second, healthcare organizations benefit from a credentialing system, as it enables them to become in-network providers with several payers that bring stability, consistency, and predictability to medical billing. In the bargain, the providers indirectly benefit from advertisements by online provider network directories. As a result, the carrier patient’s bases are accessible to the providers.
Process of Credentialing
Since the entire healthcare sector model is dependent upon the foundation of proper medical credentialing, it is important to note that this process involves many people and multiple steps, to be carried out over months. Following is the defined step-by-step process of medical credentialing:
- Thorough collection and review of the initial application is carried out to ensure that all the necessary details-education, background checks, work history, and references are included.
- The credentials are verified with the issuing institutions to confirm the authenticity of the applicants.
- A thorough secondary review is done to identify any missing details in the initial applications.
- The applications are presented to the committee for final approval.
- Continuous follow-ups are carried out to make themselves current about the provider’s credentials.
Benefits of Provider Credentialing
Since we know about the credentialing, it is important to note its potential benefits:
- Prevention of fraudulent acts through compliance. Medical credentialing helps in avoiding fraudulent acts like insecure data storage, making medical services compliant with the latest HIPPA and HITECH Act to share patients’ information and obtain its visibility with electronic health records. (HER).
- Frequent regular follow-ups. A lot of providers offer hundreds of medical services. Hence, it is vulnerable to fraud. So, they are facilitated through regular follow-ups to avoid risks while incorporating one-to-one communication between third-party experts and insurer representatives.
- Allows the insurance claim to get instantly approved. Credentialing ensures instant approval of payments and prevents its delay; hence, resulting in maximum profitability and revenue generation.
How to choose a company for medical credentialing services
An authentic company offers comprehensive and inclusive medical credentialing services to meet the established standards set by the regulatory authorities and healthcare institutes. They meticulously manage all the steps of credentialing to ensure patients’ safety and trust, as these are the cornerstones of quality healthcare. Hence, they are vigilant to maintain the delivery of quality healthcare, since they know that the market is flooded with companies offering credentialing systems.
The following are their core competencies:
1. They thoroughly review the applications to make sure that the credentials they receive are accurate and authentic.
- They have a dedicated and responsible team for completing the necessary credentialing details and submitting them to commercial insurance, such as Medicare, Medicaid, and the like.
- Their physicians are dedicated to following the rules and requirements set by the National Committee for Quality Assurance (NCQA) and the Department of Health and Family Services (DHFS) to guarantee compliance.
- As a credential services provider, they make sure the enrollment process is carried out smoothly.
- They regularly update the CAQH and PECOS credentialing portals.
- They are vigilant in conducting audits to address contracting issues and ensure data integrity.
Don’t think much. Collaborate with companies that offer comprehensive and effective medical credentialing solutions to bring outstanding medical credential services.