When your facility hires a new physician, nurse practitioner, or another healthcare provider, it’s essential to move them through the medical credentialing process. This allows you to verify their qualifications and skills while getting them listed as a medical approved provider by the insurance companies you most frequently work with.
Even if a healthcare provider has been approved by insurance panels in the past, they need to reapply each time they begin work with a new employer.
Unfortunately, medical credentialing is a time-consuming and expensive process that can occupy much of your facility’s resources. To make the system more transparent, experts here at created a guide to help you review the six key steps in provider credentialing.
There are unique physician credentialing processes for different healthcare providers. While the process is vital for physicians, credentialing is also important for:
To accept Medicare and Medicaid, you’ll need to ensure your credentialing department meets guidelines from the following federal agencies:
Centers for Medicare & Medicaid Services (CMS)
The Joint Commission on Accreditation of Healthcare Organizations
Beyond these federal regulations, each state has its own credentialing requirements. Understanding and closely following these requirements can help reduce your practice’s liability in the face of potential malpractice claims.
Yet, as we noted, credentialing is time-consuming and even tedious. To make sure your medical provider receives proper credentials in a timely manner, follow these steps.
As you begin the credentialing process in healthcare, be aware that each insurer requires different documentation and forms. You’ll need to submit complete applications to each insurer you plan to work with—and even a single missing piece of information can delay approval by weeks or months.
To ensure your applications are complete, make a list of all insurance providers you plan to file with. Then, list out any and all required documents.
These often include but are not limited to:
Hopefully, much of that information was reported in your provider’s resume and application. However, you’ll need to take steps to ensure its accuracy.
Because you’ll need to submit multiple applications, it may be advantageous to prioritize which dossiers you submit first.
Make a list of your priorities and begin to assemble documents and applications accordingly.
As you begin to assemble required documents and begin individual applications, keep in mind that the quality and accuracy of information is key.
Before submitting any application, take the following steps:
Any errors in the submitted information can cause issues. For example:
Once you’ve assembled and verified these documents, you’re ready to present them to facility leadership, who will determine the specific privileges to grant to the new provider. This information is vital for the credentialing application.
Should your facility manually verify provider information or use an alternate method?
Some healthcare facilities choose to credential the old-fashioned way, calling and emailing medical schools, the American Medical Association, and other key organizations to verify the information on a provider’s resume.
However, this can be incredibly time-consuming, and any cut corners could result in further delays.
Once you’re sure you have accurate information, you can proceed to the next step.
Don’t just wait five or six months to hear from an insurer. Credentialing healthcare professionals reveal that consistent follow-ups are key to timely approval.
Eventually, your provider will receive their insurance panel credentialing. However, that doesn’t mean they’ll be credentialed forever.
Unfortunately, credentialing is an ongoing process that requires more work down the line.
As we’ve noted, credentialing software can help you manage credentialing. Likewise, it should notify you when it’s time to renew a specific provider’s credentials.
However, insurers should also send a notification after three years have elapsed. Respond in a timely manner to ensure your provider can provide patient care without interruption.
Contact Softlogan today to see how you can avail our medical coding services as a stand-alone plug and play service or part of the healthcare revenue cycle management services suite.