Why Do Providers Need To Be Credentialed?

27 April 2022
Why do providers need to be credentialed?

It is paramount for any new physician or any other healthcare provider to go through Medical credentialing if being hired by any healthcare facility. This step is crucial to ensure that their qualifications are carefully verified to list them as qualified medical approved providers by the various insurance companies frequently contacted for work.

Despite being approved earlier by the respective insurance panels, any healthcare provider needs to reapply once again if they decide to join a new employer. Provider credentialing is a lengthy and costly process that uses the healthcare facility's resources.

Initially, it was required to submit all the necessary documents with each insurance payer to get credentialed individually. And it is the same even now for some instances. While recently, most insurance companies have started using a centralized database. The most frequently used credentialing web database in recent days is the Center for Affordable Quality Healthcare, Inc. (CAQH). CAQH's online database happens to be the Universal Provider Database (UPD). As per the Provider credentialing checklist, all the required information gets gathered and concerted for credentialing, and the same is provided to the payers.

Significance of Physician Credentialing:

If a new physician is hired to the medical practice, they need to consider credentialing on a severe note without being deferred. Or else it sure would be a big dipper and delays caused by mounting cash flows. When the Physician Credentialing is carried out effectively, it can ensure you of generating healthy revenue and avoid unnecessary delays. 

To be a part of the several insurance networks covered by the Payer and to render medical service to the patients who are members under the Payer's plans is pivotal for efficacious provider enrollment and credentialing. 

It is fair enough to mention that credentialing process is also essential for several other healthcare providers such as those who offer physical therapy, the ones who hold a license for massage therapy, dentists, various hospital and health agencies, psychologists, and counsellors.

Key Benefits of Streamlined Provider Credentialing:

Through a streamlined physician credentialing process, you can be assured that the healthcare providers are professionally experienced and certified and have ample training to render medical care appropriate to the patients. From the healthcare facility's perspective, lack of credentialing results in a mounting due of reimbursements. It brings the growth of the healthcare facility to a standstill.

The following are some of the significant benefits of any practice if they follow a streamlined credentialing process.

1. Wins the patients' confidence The process of healing for any patient mainly depends on their perspective. When they trust the physicians confidently, following their orders to a specific change in their diets, trying a different medication, or following a particular exercise routine becomes easy. And once they gain that confidence, the patient is retained by the practice for further treatment. They right away rule out seeking any other competent physician from other healthcare facilities.

The organization's visibility is outstanding and has become quite appealing to the entire team of medical care providers within the facility. 

2. Avoid unnecessary lawsuits against the practice –The providers' mandatory compliance and best practices are being covered by credentialing. It holds well in compliance with the state and federal regulations. Unnecessary lawsuits against the practice could be avoided, thereby protecting the healthcare facility from unexpected costs such as fines or civil monetary penalties, allowing them to enjoy a healthy revenue cycle.

3. Much needed for the compensationIn the case of receiving reimbursements from the insurance companies, it is essential to be medically credentialed. Prompt documentation assures that a newly hired physician or a nurse practitioner can render medical services the very same day they are hired.

The complete documentation must be completed at the earliest from the applicants by most of the organizations. The time window differs depending on each state due to the regulation and credentialing law differences. The proof for medical credentialing is requested to be verified initially by the case of private health insurance companies such as Medicaid and Medicare to allow the staff to render medical care for the patients. 

4. Minimized medical errors– The importance of medically credentialed providers has flared up due to the high rise in deaths caused by medical mistakes. It is the right of any patient to know and be assured that they are in safe hands and that their providers know what exactly they are doing.

The whole industry's security and safety are strongly upheld when the health professionals are medically credentialed through proper means.

5. Stay affirmed about your sufficient staff levels Medical credentialing comes to your rescue when you face problems maintaining enough staff levels to serve the community better.

If a staff that is not hired through a placement agency joins your healthcare facility, you should start the credentialing process right away. It is a tedious and time-consuming process. Hence, it would benefit the staff and the organization if you hand out credentialing packets to the newly hired staff to offer support throughout their application process.

Keeping track of their process status by your human resources department helps you identify any obstacles that might further delay the onboarding of the new staff.

Streamline Your Provider Credentialing Efficiently With BIS:

Instilling confidence within the patients to trust the physician for the best medical care calmly and retaining the patient to seek their assistance instead of running towards other healthcare providers is the foremost goal to have a splendid revenue generation. Minimizing medical errors and ensuring sufficient staff levels within the practice helps you serve the community better.

Business Integrity Services, with our many years of integrated experience and exhaustive knowledge, aids you with efficiently streamlined provider credentialing services. We allow you to cut down on costs, avoid delays and enjoy a healthy revenue generation.