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10 Tips for Professional Credentialing Services

Credentialing services, start the references method ahead of time to avoid problems, whether you’re introducing a new doctor or establishing your own practices.

If you ignore the need for credentialing, you will face cash flow problems, scheduling difficulties due to patient restrictions

What Is Credentialing?

Needed to verify a physician’s school attendance and state licensure is the process of physician credentialing. It also includes identifying the physician’s employment and evaluating his or her malpractice insurance.

Credentialing also entails a review of the provider’s criminal and financial history, as well as, increasingly, their social media history. It’s a lengthy procedure that could take longer than expected, so plan accordingly.

Here are ten quick tips for performing effective provider credentialing.

Assign a Credentialing Services Coordinator to your project

It’s smart business to allocate a credentialing coordinator to stay on top of deadlines and expirations, whether you outsource healthcare credentialing services or handle them in-house.

Allow time for the Credentialing procedure

While accreditation “should” take 90 days, beneficial procedures allow for 150 days. Credentialing with payers must adhere to their schedules, which differ from one another.

Expect credentialing to take 150 days, and be pleasantly surprised if it takes less.

Follow the Coalition for Affordable Quality

Payers are urging behind the Coalition for Affordable Quality Healthcare (CAQH) standard, which supports the program.

Interfacing with this software is advantageous because physicians who update and attest their information with the CAQH on a regular basis have more efficient credentialing and re-credentialing experiences.

Tie the start date

Many offices will ask for approves documentation as soon as an offer of employment is made. Others attach the start date of a new physician to the completion of paperwork.

For example, you may schedule a new physician’s start date 120 days after receiving his or her certification information.

Establish a Long-Term Credentialing Services

Creating the workflow of a credentialing service is difficult, but it pays off in the long run. Even if you outsource the clears process, your workflow should keep track of all essential papers and documents.

Re-credentialing seems to be a constant in a multi-physician practice and having a workflow available to encourage it is extremely beneficial to the organization.

Don’t Assume That

Some payers will allow you to bill for a new physician whose credentialing is incomplete if you designate them as locum tenens (basically a fill-in physician).

It’s preferable to have the physician properly certified so you may bill normally, but if that’s not possible, at the very least contact payers to learn about their policies.

Make sure all of your doctor’s contact information is up to date

Ensure that your office manager or references coordinator has accurate and up-to-date contact information for all of your physicians.

Dealing with credentialing or re-credentialing issues can take longer than it should if you don’t have direct touch.

In order to complete the credentialing process, multiple documents must be submitted, and clear communication is required at all times.

Ensure that all physicians are aware

Every provider should be aware of his or her obligations in terms of certificate and re-certificate.

As soon as the job offer is made, make it clear to the new hire that you require specific information, such as work and education history, credentialing, and license information.

Get a head start on the Credentialing Services

Many practices prefer to conduct their own background checks on incoming physicians before making an employment offer.

It may appear to be excessive, but it can save you from hiring a doctor only to have licensure issues later on.

Become well-versed in your state’s regulations 

Your state’s licensing laws, as well as reciprocity agreements with payers and other state certification bodies, may exist.

Credentialing services for the new job may be facilitated if a physician becomes certified with a payer in one state before relocating to your practice.

Understanding how healthcare credentialing works can have a significant impact on how well a practice operates and how quickly money is received.

Certificate issues may be costly and time-consuming, so it’s critical to have a procedure and a plan in place to ensure that credentials are constantly up to date.

ALSO READ: Role of Medical Billing Services in Maintaining a Successful Practice 





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