If You Think You Understand Enrollments, Then This Might Change Your Mind

Important Information that You Should Know Regarding Physician Credentialing

Physician offices, the managed care insurance companies and the hospitals as well as the laboratories all credential their physicians. You have to know that credentialing is actually the act of gathering information about the doctor or medical provider to verify their qualifications when it comes to practicing medicine in their specialty.

Know that there are many agencies which actually oversee the credentialing processes. There is one leading agency that monitors the credential and the qualification standards in healthcare. Medical providers must go through the process of credentialing before they are hired by the medical facilities or the insurance companies. Physician credentialing or medical credentialing is going to verify the training, licensure, quality, education and also the general ethical standing of the provider in a particular medical community.

The process of credentialing is going to start by submitting the required information to the credentialing agency for evaluation. The areas of focus would include the licenses, education, board certification, background check, malpractice claims, resume and the detailed work history, privileges, personal preferences, the malpractice insurance and several others.

The information gathered are going to be reviewed by a physician peer-review committee. The committees would actually make recommendations to the professional as well as the standing of the provider in the community. The committees would also evaluate the ethical behavior of the physician.

The insurance companies, which include the government-sponsored payers, will research the physician’s medical credentials before accepting the professional into the group of the participating providers. The Medicaid and the Medicare will not permit the physicians not undergo the credential procedures to bill for services. Managed care organizations do have such strict physician credentialing process before the provider is listed as participated with the insurance company. So many private physician practices are going to credential the doctors to ensure quality care delivery.

You must know that the provider credential is a way to assure the consumers that medical providers have actually been reviewed by the peers. This would also provide such higher level of trust and ensure that the provider is licensed and also certified and hasn’t had their licenses or their privileges revoked by the other state. However, it can’t determine the quality of the delivery of care by the provider. So many credential committees implemented policies that the providers must participate in like periodic credential updates and reviews to keep the status current.

There are a lot of companies, such as medical practice consultants, specializing in the provider credentials. Such companies would consult with the medical facilities and the provider practices in order to monitor and also ensure that the physicians’ credentials are kept updated and current.

Source: Payor Enrollment