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Four Common Medical Credentialing Problems

Four Common Medical Credentialing Problems

All certifications, trainings, licenses, education, etc. need to be checked out prior to their start date.

Medical Credentialing is a process used to evaluate the qualifications and practice history of a doctor.  This process includes a review of a doctor’s completed education, training, residency and licenses.  It also includes any certifications issued by a board in the doctor’s area of specialty.. Before a doctor can practice at a medical organization, their credentials not only need to be verified for accuracy, but added to the organization’s payers.  All certifications, trainings, licenses, education, etc. need to be checked out prior to their start date. Medical credentialing is typically a laborious process but is always necessary.  Unfortunately, problems sometimes arise within the credentialing process; however, there are several steps you can take to ensure this process runs as smoothly as possible.

Not Completing/Incorrect Applications

This happens all the time.  Before an application is submitted, it should be double and even triple-checked for accuracy.  If you want to avoid denials and delays, you need to ensure that an application does not contain any errors and is filled out entirely.  A credentialing application will ask for important pieces of information such as contact information, employment history, phone numbers, and other important records.

Neglecting To Follow Up

In order for credentialing to be a successful process, an organization needs to continuously follow up with its payers. You need to stay on top of them to ensure they are processing your applications in a timely fashion.  Don’t be afraid to reach out to them to check on the status of the applications. Try to get in the habit of contacting them on a routine basis to monitor the status of your submissions.

Waiting To Start The Process

There is no time for procrastination in the credentialing process.  You need to get the train rolling as soon as possible. It can take a while to complete a thorough background check of a doctor, so you  will want to give your organization at least a couple of months before any doubts set in just in case there are any issues.

Not Assigning Roles To Your Staff

Since there is so much that goes into the credentialing process, you need to have a competent team in place to ensure it is always running smoothly.  All too often, organizations do not assign roles for staff members to manage the workload. For example, you need people who will enter data/ensure its accuracy.  If there are loosely defined responsibilities within your organization, it will cause errors which will lead to denials and delays.

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This entry was posted on Monday, May 7th, 2018 at 3:33 pm. Both comments and pings are currently closed.