Medical Credentialing Services
Medical credentialing involves the process of checking the background and educational history of licensed medical professionals and verifying their qualifications. The aim of credentialing is to protect patients by ensuring that practitioners are qualified and legally able to provide healthcare in their state. It also ensures that healthcare providers will get reimbursed by insurance providers.
The complete credentialing process can take between 90 and 120 days. Not only is the process long, but it can also be complicated. A physician credentialing service can lighten the burden by assisting you with documentation and giving your regular updates on your application’s status.
What Does Medical Provider Credentialing Involve?
To get your medical provider credentials, you will typically have to go through three phases. On average, you can expect to pay around $200 per plan provider. You can save money by using a credentialing service. Medical credentialing involves the following steps:
Submitting information: You are required to provide the health insurance provider with information about your background, medical education, and any license you hold.
Information verification: The insurance company will then check the information you have provided by corresponding with medical schools, licensing boards, etc.
Credentials awarded: Once all your information has been verified, so long as no issues arise, you will be awarded credentials.
When you use a medical credentialing service, you provide them with this information, and they will submit it for you. They will also send you automatic updates on the status of your application. Outsourcing credentialing can save you time and money and is more efficient than contacting individual insurance providers yourself.
What are the Benefits of Medical Credentialing?
Medical credentialing is essential for the following reasons:
- Improving patient trust: Trust is the very foundation between healthcare providers and their patients. Without it, patients will not feel comfortable talking about their health. However, when patients know about their physician’s qualifications and experience, it allows them to trust their chosen provider.
- Preventing revenue loss: Credentialing is necessary for you to partner with insurance providers and receives reimbursement for services provided. Failure to get your credentials before you begin to practice can cost you thousands of dollars. Sometimes, your medical office may allow you to practice while you are waiting for your credentials. In this case, the insurance carrier can backdate the reimbursement.
- Improving your reputation: Every healthcare practitioner wants to maintain a healthy reputation. By undergoing the credentialing process, you are permitted to treat any patient, whichever insurance plan they prefer. This means your patients’ demographic scope is diverse, and your reputation will be solid across the board.
- Enhancing your prospects: Because medical credentialing entails a thorough assessment of your medical education and background, it is an integral part of the hiring process. Medical groups use credentialing as part of their vetting procedure for potential hires because it shows that you have proven skills, training, and licenses. Credentialing demonstrates that you are qualified to do the job you are being hired to do and protects the health organization from potential lawsuits.
- Medical Recredentialing Policies: You will need to renew your medical credentials every 36 months. You will be notified by your medical credentialing service or by the credentialing department 180 days in advance of your credential expiration date. To avoid a lapse in your credentialing status, you should make sure that all your documentation is up-to-date and available at the time of reapplication. If you fail to renew your credentials promptly, you will have to undergo the initial credentialing process.
Top Players in Medical Credentialing
Here are some of the best medical credentialing service providers:
- PrognoCIS Electronic Health Records: PrognoCIS provides a software solution for medical credentialing. It can be used as a locally hosted software or cloud-based.
- MedUSA: MedUSA is a Revenue Cycle Management Company (RCM). Medical credentialing services offer medical coding, billing, and transcription services to practices, clinics, and hospitals.
- Newport Credentialing Solutions: Newport specializes in cloud-based, IT-enabled medical credentialing solutions.
- Ninety Nine Healthcare Management: With Ninety Nine Healthcare Management, you can benefit from practice start-up, practice management, and medical billing services.
- Kareo: As well as medical credentialing services, Kareo also provides medical billing and patient portal solutions.
We are a leading medical billing and credentialing services provider. We can help you verify your medical credentials, so you can focus on building your practice. Contact us today to find out more about how we can help ease your medical credentialing burden.