In 2021, only 20% of Americans said they have a “great deal” of trust in the medical system. One of the biggest problems that affect all segments of the healthcare industry is the lack of transparency. This causes confusion and distrust for patients.
Yet, healthcare providers follow many rules and regulations. They are to keep patients safe and help them navigate their healthcare options. Unfortunately, patients are still in the dark about them.
So today, you will learn about the credentialing process in healthcare. Keep reading, and let’s dive in.
What is Medical Credentialing?
For healthcare providers, medical credentialing is the process of getting networked with insurance companies. For physicians, it is how employers guarantee the applicant is who they say they are.
The provider credentialing process is necessary to create a network of healthcare professionals, providers, and insurers. It establishes who has the proper qualifications to perform their jobs. Furthermore, the process gives confidence to patients. This allows them to trust their healthcare providers.
The National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC) created the standards and rules for medical credentialing that health providers follow.
The Steps in the Credentialing Process
There are several steps in the medical credentialing process, which all need a significant amount of work. Most healthcare organizations have a designated credentialing expert or manager to help guide the process.
As you move through the process, it’s essential to have all the information organized and up-to-date. The credentialing process can take up to 180 days. Thus, it is crucial to start early.
The first step is to fill out the credentialing applications. For this, you need to collect the following information:
- Education, training (residency), board eligibility, and certificate
- Work history and current employment status
- Clinical privilege history
- Clinical report cards and performance reviews
- Professional reference list
- Malpractice insurance
- Attestations of extra licenses and registrations you hold
When noting your education and work history, you need to explain any gaps of more than 30 days.
Also, you need to explain any claims on your malpractice insurance, if applicable. Further, you must disclose any sanctions on your record, a criminal background check, and your health status. Finally, if any physical or mental illnesses could affect your work, you must disclose them too.
Tips to Follow
To avoid delays in your provider credentialing process flow, you must ensure your information is 100% accurate. Do not leave anything out. Thus, it is best if you already have all this information handy before applying for positions.
This includes knowing your state’s regulations. Credentialing laws can vary between states. Moving from one state to another could mean going through the process again. An in-state transfer may allow for a streamlined process.
To get the most recent information on the state’s standards, ask the state Medical Group Management Association.
Ask for Help
If the credentialing process sounds overwhelming, you’re not alone. Thankfully, there are excellent medical credentialing services available to use. Finding a highly effective credentialing team like those at 5ACVO will benefit you.
In many places, credentialing is still a manual process. Working with a credentialing team or software can help reduce errors with your information. In turn, this will speed up the process.
The Coalition for Affordable Quality Healthcare (CAQH) has a uniform credentialing program. Most health insurance payers use it across the US. You should always keep your CAQH current, so the credentialing process is faster.
If you’re a new physician or healthcare provider, you won’t be able to start your CAQH application right away. First, an insurance company needs to invite you to register. Then, after accepting a position, follow up with the insurance company. This ensures you can fill out the application promptly.
Always select the online CAQH application option. Avoid using a paper copy. It saves time, cuts down on errors, and is easier to update.
Privileging and Paying Enrollment
Along with credentialing, you also need to go through privileging and enrollment. All three processes begin when you start credentialing.
The privileging process allows you to perform specific services at the intuition based on your credentials. Paying enrollment enables you to bill patients and receive payment for those particular services. You get entered into insurance plans, networks, Medicare, and Medicaid.
Follow the Process
After submitting all the information, you can follow the process. Cloud-based credentialing is easier to follow than manual credentialing. You can access an app to get updates and alerts as things proceed.
The Advantages of Credentialing
Medical credentialing is beneficial for several reasons. Most importantly, it ensures quality assurance and patient safety. In addition, credentialing demonstrates which healthcare providers are competent to perform their services.
The process ensures high-quality service and keeps patient safety a top priority. Enhanced quality and safety lead to less revenue loss for providers. In the long run, it means lower costs for patients too.
Of course, patient safety leads to better trust between providers and patients. This trust is crucial for everyone in the healthcare industry.
Credentialing also improves practice reputation, which brings more patients. Patients are doing more research now than ever before. They get informed about healthcare practices and physicians before committing to them.
With the lack of transparency, Americans are increasingly concerned about who they see for medical services. There is no comparison between accreditated and unaccredited healthcare providers.
Start Your Credentialing Today
Even though the credentialing process can be a pain, it’s necessary to practice medicine or join a healthcare organization. Remember, you don’t have to go through the process alone. There are many suitable service providers and software accessible to help you.
For more information like this, check out the Health section.