Credentialing

Credentialing

Credentialing refers to a process of reviewing healthcare provider’s credentials so that a patient can verify their professional standing before seeking medical help. Every medical professional should go through this new practice credentialing before changing states or starting a new practice. Medical credentialing comprises healthcare provider credentialing and provider enrollment. Provider Credentialing is the process of authenticating the training, skills, qualifications, licensing, etc., as mentioned above. Provider Enrollment is the procedure of registering a healthcare provider with insurance plans like Medicare and Medicaid. Credentialing also called primary source verification is an intensive process whereby the insurance company conducts a background check on the physician. They verify the healthcare provider’s education, competencies, and legal authorization to practice medicine. There is a turnaround time involved in this course of process. If everything checks out, then the insurance company extends a partnership contract to the provider to include them in the network of providers. Trying to navigate the credentialing process is overwhelming and often costs more time and money than working with a professional that is knowledgeable of the process and can advocate on behalf of the provider. Hence it helps medical professionals develop a thriving practice, which is vital for insurance reimbursement.

Our clients often tell us that they don’t have the means to afford an outsourced credentialing service and review their physicians in-house. However, after reviewing, we’ve discovered that managing medical credentialing in-house is more costly than outsourcing it. The most significant benefit of outsourcing a credentialing service is that all the efforts can be strengthened. Professional services can carry out credentialing for several physicians, which can save you time and money.