What is Credentialing and Why Is It Important?

What is Credentialing?

Credentialing is the process by which a practitioner’s license, education, training, experience, and other qualifications are verified in order for them to provide care or services in or for a health care organization.  This process’ role is to help maintain standards of quality in the medical community for the benefit of patients. Credentialing is also how a practitioner becomes an “in-network” provider for insurance companies. It is an ongoing process that has to be revisited every few years, depending on which state you are in and which insurance companies you are associated with.

Why is it Important?

Medical credentialing is important because it is the one process that allows patients to confidently place their trust in a chosen healthcare provider. This process vets the background and current competency level to ensure the practitioner is qualified to practice medicine. All practitioners go through this comprehensive review before they can provide services to patients through a practice or healthcare facility. It is also necessary for insurance companies, Medicaid and Medicare in order for practitioners to be contracted and get paid for services rendered through those payers.

What Information is Required?

Credentialing is about more than just where a practitioner went to school. There is a long list of information and documentation that has to be provided, such as:

• Full Name
• Citizenship
• Recent photograph
• Copy of current state license
• Copy of DEA
• Provider NPI Number
• Educational background (must include month/year of attendance, name/address of the institution, program director’s name, and degrees received)
• All past, present, and pending hospital affiliations
• Practice specialty
• Work history
• Professional certificates
• Board certifications
• Professional liability insurance
• Malpractice claims history
• Peer references
• Criminal history
• And more

Credentialing is a very in-depth process and can take anywhere from three to six months or more to complete.

Who Handles Credentialing?

In a practice or healthcare facility, someone on staff, such as a designated credentialing expert or practice manager, is charged with handling all of the ins and outs of the credentialing process. Whether it is providing documentation and information on one of their practitioners or requesting and organizing information on someone wanting to join their practice. Any or all of these aspects take time, lots of time. Credentialing is an arduous task. Between phone calls, multiple requests, and follow-ups the time staff utilizes for credentialing could, and should, be spent on providing quality patient care.

Can Outsourcing Help?

Streamlining workflow, maximizing all your assets, and managing how your staff’s time is spent all feed into your practice’s bottom line both financially and with your patients’ experience. Removing time-consuming administrative tasks and outsourcing them to an expert can both improve your workflow and time management by allowing staff to focus on providing quality patient care.

There are several benefits to outsourcing your credentialing:

• Give practitioners more time to concentrate on patients
• Reduces the amount of paperwork
• Give you the advantage of having experts do the job
• Removes hours of frustration

Although your practice’s main priority is treating patients, going through the process of credentialing is necessary to remain financially viable.

How We Can Help?

Billed Right is a revenue cycle management company that also offers additional virtual back-office services, such as credentialing, to be able to provide practitioners with multiple ways to help streamline their workflow, increase their revenue and grow their business.  We see our role as a partner, not just a vendor, and work to help all facets of practice management, not just Revenue Cycle Management.

As your credentialing partner here is what you can expect:

• All credentialing for Medicare and commercial carriers
• Collection of all necessary documentation
• Completion of enrollment forms for insurance carriers
• Follow up with insurance carriers until applications are approved
• Tracking of providers for re-credentialing purposes

Billed Right can help by allowing you to focus on your practice and patients while we handle the paperwork.

Contact Billed Right today to see how we can take the burden of credentialing off you and your staff.