Physician credentialing is the process of determining that the physician is authorized to provide services and medical care to the patients who are part of a payer (i.e. medical insurance company). Likewise, it ensures that the physician is a member of the payer’s network. Provider credentialing verifies the physician’s ability to meet the standards of the payer, and it is done by reviewing his or her license, certifications, experience, training, adverse clinical occurrences, malpractice, clinical judgment, affiliations, and education. While you have the option to verify the credentials of doctor or healthcare specialist, you could save time and effort by having it outsourced to a qualified credentialing verification provider.
Why leave it to a specialist?
An effective provider credentialing expert will improve your practice and the way you run your medical facility. The absence of proper enrollment could cause the delay or refusal of payments by your patients’ insurance carriers, even if you have doctors who are able to provide medically necessary and competent treatment and services. A credentialing verification provider has the right manpower, tools, and connections to help you enhance revenues through a tailor-made service, which can facilitate a payer enrollment process when a physician wants to become part of a new payer network or when you are adding a new physician to your existing group.
Provider credentialing can help a physician start with their practice straight out of medical school, or switch from one practice to another, as the service can serve as a guarantee of their capabilities and expertise. It is important to note that different payers maintain their own sets of forms, which means a lot of paperwork online or offline. Once submitted, you need to follow-up regularly to make sure your revenues will not be affected. A credentialing verification provider can help speed up the process by providing services such as new provider affiliation and group credentialing, handling the provider letter of interest and the application requisition from payers, and facility credentialing, which can include the addition of the provider to your facility’s identity.