Guide Well Credentialing Services

The process by which healthcare organizations review and authorize physicians and other practitioners to provide care within their networks is known as credentialing. Credentialing is an important safety component of the healthcare system because it verifies whether a physician is qualified to practice. Because insurance companies will only pay claims from credentialed physicians, credentialing could be considered the first step in the revenue cycle management process.

A credentialing application typically necessitates

• Education history and transcripts
• Work history in detail
• Current medical license, board certification, and DEA registration are required
• Personal health history and immunization records that are up to date
• Evidence of continuous malpractice insurance coverage
• References, both personal and professional
• Complete explanation of any historical gaps or other anomalies

What Are Credentialing Services?

A credentialing service organizes and manages credentialing applications for physicians and other stakeholders, ensuring that the credentialing process runs smoothly. Guide well credentialing services are usually better equipped than physicians or their staff to resolve any delays or issues in a timely manner because they have detailed knowledge of the credentialing process and are not distracted by other tasks. Ideally, this means that credentialing takes less time overall, necessitates fewer physician and staff resources, is less expensive, and (perhaps most importantly) allows the physician to begin billing for services sooner.

Credentialing services typically offer three types of services to practitioners:

• Initial certification services
• Services for re-certification
• Expirables management

Why is certification so important?

Guide well credentialing is becoming increasingly important because it is the only procedure that allows patients to put their trust in their chosen healthcare providers with confidence. Our credentialing processes provide organizations with efficiency, reducing the burden on all stakeholders while improving quality.

 Guide well Credentialing also refers to the process of validating that a provider meets the standards set by the state, employer, or insurance company, which is performed by many credentialing companies across the United States.

The true worth of your time

While credentialing is an expense in and of itself, the true cost of credentialing is the time a physician is working – or not working. A delay in credentialing can result in time away from work or from seeing patients with certain insurances. The cost of lost income due to delays can easily exceed the cost of credentialing itself. Credentialing can also take a long time, especially if things go wrong. Physicians frequently undervalue their own time, and the last thing you want to do is wait for a credentialing service to call you back.

Our credentialing team will always call you back as soon as possible. We specialize in complicated credentialing projects, and we frequently succeed where others have failed.

Guidelines for a Smooth Provider Credentialing Process Flow

Provider credentialing also includes a background check on the provider’s criminal, financial, and social media history. References will also be checked. It’s a time-consuming process that may take longer than expected, so plan accordingly. Here are some pointers for a smooth provider credentialing process.

Name a Credentialing Coordinator.

Whether you outsource or handle credentialing tasks in-house, appointing a credentialing coordinator to keep track of deadlines and expirations is a smart business decision. They can send out timely reminders to ensure that no one’s credentials expire and reimbursements are not denied as a result.

 Allow enough time to complete the credentialing process

While credentialing “should” take 90 days, practical procedures allow for a 150-day turnaround. Credentialing with payers must take place on their schedule, which varies. Expect credentialing to take 150 days, and you’ll be surprised if it takes less.

 Stay up to date by following the CAQH Credentialing Program

The Coalition for Affordable Quality Healthcare (CAQH) standard credentialing program is becoming more popular among payers. Interfacing with this software is beneficial 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 of the new provider to the submission of credentialing forms

Many practices require credentialing documents as soon as an employment offer is made. Others associate the start date of a new physician with paperwork submission. For example, you can begin hiring a new physician no later than 120 days after receiving his or her credentialing information.