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Medical Credentialing Best Practices

Medical Credentialing Best Practices

Since getting through this process can take a while, it is in your best interest to get started right away.

Before a new medical practice can offer its services to patients, it needs to become connected with insurances companies in order to receive financial reimbursement. To put it simply, credentialing checks a doctor’s credentials before they start working at a medical organization. The following are three best practices for medical credentialing to help your practice avoid unnecessary and avoidable delays.

Begin The Process Right Away

Medical credentialing is a thorough process. It involves conducting background checks, reviewing malpractice insurance, the physicians schooling, and medical licenses. Since getting through this process can take a while, it is in your best interest to get started right away. In some cases, credentialing can take as long as six months, but usually can be completed within 90 days. The medical credentialing requirements vary from state-to-state so be sure you know what is required of your practice. Since medical credentialing is out of your hands, and the payer is essentially in control of the application process, you should always give yourself more time than you initially anticipate.

Stay On Top Of The Insurance Networks

It is not uncommon for insurance networks to make mistakes while processing applications. For that reason, you want to remain involved in the medical credentialing process after you submit your application. In other words, do not submit it and think you are out of the woods. You want to be sure to keep following up to ensure everything is in order.

Ensure All Key Pieces Of Information Is Present And Accurate

In order for the application process to run smoothly, all critical pieces of information need to be present, organized, and easily accessible. In addition, you want to ensure that everything is up to date. An example of such is the malpractice which expires on an annual basis. You want to double check you include the correct start date for the physician at your practice, attestations, work status, and work history. As a general rule of thumb, it is better to provide too much information than too little. If you can avoid delays, the process can usually be completed within a three-month timespan.

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This entry was posted on Thursday, July 5th, 2018 at 1:01 pm. Both comments and pings are currently closed.