It is a process by which insurance companies and hospitals check a medical provider’s credentials. This includes license verification, malpractice insurance verification, college degree verification, and background checks to ensure that the provider is fully capable of providing services and has no prior negative actions or convictions.
What is the significance of credentialing? Who does it matter to?
It is critical for the provider to maintain his credibility with insurance carriers in order to obtain a contract to participate in the various programs offered by insurance companies in California. This is critical for a medical provider because most of us prefer to see a doctor in our network because it saves money on our medical bills. Most out-of-network benefits impose a deductible, the patient, before any payments to the service provider are made.
Your healthcare business – whether it’s a hospital or a private clinic – must go through or have gone through a rigorous credentialing process in order to receive smooth reimbursement from insurance companies. Credentialing, on the other hand, can strain your already-strained resources because it necessitates meticulous verification of the healthcare provider’s credentials, such as medical licenses, certifications, internships/fellowships, malpractice insurance, DEA/CDS registration, criminal background check, and more.
Why are we here?
- Verification of a large number of physicians, healthcare providers, and Medicare facilities
- Personalized facilities and technical assistance throughout the credentialing process in California
- Throughout the documentation process, and complete accountability
- Payments from insurance providers are becoming more convenient, resulting in an increase in revenue
- Reduced out-of-pocket expenses result in cost savings
- For smooth billing operations, become a recognized and affiliated member of a large network of insurance firms
- Credentialing in a variety of healthcare disciplines and medical practices
Requirements for Credentialing
Specialty board certification from a recognized U.S. specialty board, such as the American Board of Medical Specialties (ABMS), or successful completion of a U.S based residency in your specialty or area of practice, if applicable. General practitioners must have completed one year of postgraduate training and two years of training in the specialty program they are requesting.
- A valid, unrestricted medical license issued by the appropriate licensing board in California. The probationary license status is considered restricted.
- A completed professional malpractice liability questionnaire, as well as an explanation of all claims, settlements, and pending cases.
- There are no outstanding licensing issues, such as an unresolved accusation from the board that issues the applicable license to practice.
- A current unrestricted Drug Enforcement Agency (DEA) registration number, if applicable.
Do you require assistance?
We can make credentialing services and the contracting process for your medical practice quick and easy with state-of-the-art software programs and our credentialing experts. We work with all specialties across the country and can help you get credentialed for any help plan.
Medical Credentialing Outsourcing Lowers Operational and Administrative Costs
Streamlining your electronic transactions, standardizing your reporting requirements and provider enrollment, and the credentialing system, according to David Cutler Ph.D., Elizabeth Wikler B.A., and Peter Basch, M.D. in an article published in the Harvard Journal of Medicine, is one of the best solutions to your cost concerns. What kind of savings are we talking about here? In a year, it is estimated to cost $29,000 per physician.
Errors are reduced, which leads to a faster medical credentialing process
You’ll be working with expert medical credentialing professionals who are skilled and knowledgeable about all the latest updates to the medical credentialing process when you use a third-party provider. This ensures that your enrollment submission is error-free. As a result, your practice’s enrollment process is faster, allowing you to earn more money.
You’ll have more time to focus on growing your practice
A physician in the United States spends an average of 43 minutes per day on administrative tasks related to health plans. This equates to 261 hours of time saved per year (365 days).
You can no longer worry about these administrative tasks because an outsourced medical credentialing provider will take care of them for you. Your time could be better spent focusing on growing your practice and providing better services to your patients.