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Understanding the Basics of Credentialing and Why it Matters

Understanding the Basics of Credentialing and Why it Matters

Credentialing relates to the method of checking a doctor’s background and work history.

Before a doctor can begin with any medical organization, their credentials must be verified through a thorough process.  While commonly referred to as Medical Credentialing, Physician Credentialing, or Provider Credentialing, Credentialing relates to the method of checking a doctor’s background and work history.  The information included in these checks involves training, licenses, certifications and prior educations.  Keep reading for an overview on the basics of credentialing and why it matters in the medical community.

Credentialing Follows State Regulations

State requirements differ in regards to Medical Credentialing.  Some states require regulations such as reciprocity regulations.  With this, it is important to ensure that you are complying with the requirements of your state should you choose to use credentialing as a resource.

Credentialing Takes Time

Medical Credentialing usually takes anywhere from three to five months.  Since credentialing is a long process, a quicker start can be more beneficial for receiving the information sooner rather than later.  Delays are common because critical pieces of paperwork are either left out or incomplete when the data is submitted for approval. To prevent delays, it is important to check documents for accuracy and completeness.

Credentialing Requires the Correct Information

It is crucial to ensure that your information is recorded accurately in your initial attempt to avoid an inconvenient delay with credentialing.  Information is often recorded incorrectly, expired or omitted altogether. If individual pieces of information are left out, such as sections of work history, the data may not be entirely accurate for your use.  Other examples, such as missing start datesmay also affect processing. Though they seem small, these missing pieces of information are capable of delaying the credentialing process, making fact-checking a crucial component of submissions.

Credentialing is a Process that Should be Monitored

By monitoring the progression of the credentialing process, you will be able to mitigate further delays to the process.  With this, organization plays a crucial role in overseeing this process by maintaining information on where each medical professional may stand in the credentialing process.  New doctors should avoid providing services until the credentialing paperwork is complete and confirmed with a letter. This will help to prevent costly issues in the future, should any problems arise at the practice.

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This entry was posted on Wednesday, August 29th, 2018 at 4:23 pm. Both comments and pings are currently closed.