Tips for Credentialing
Medical Credentialing Services
Medical credentialing services play a crucial role in the healthcare industry. These services ensure that healthcare providers, such as physicians, nurses, and other medical professionals, meet the necessary qualifications and standards to practice medicine and provide quality care to patients.
Medical credentialing involves a comprehensive evaluation of a healthcare provider’s education, training, experience, licensure, certifications, and professional background. The process is typically carried out by specialized credentialing organizations or companies that have expertise in verifying and assessing the credentials of healthcare professionals. Here are some key aspects of medical credentialing services:
Verification of Education and Training: Credentialing services verify the educational qualifications of healthcare providers, including their medical degrees, residency training, and any specialized training or fellowships they have completed. This step ensures that providers have received appropriate education and training to practice in their respective fields.
Licensure Verification: Credentialing organizations confirm the active and valid licensure of healthcare professionals. They verify the licenses with the relevant state medical boards or licensing authorities to ensure that providers have met the requirements to practice medicine legally.
Work History and Professional References: Credentialing services investigate the work history and professional references of healthcare providers. This includes verifying previous employment, assessing clinical competence, and obtaining references from colleagues or supervisors to gain insight into the provider’s professional conduct and performance.
Malpractice History: Credentialing organizations review a healthcare provider’s malpractice history to identify any past legal or disciplinary actions. This step helps assess the provider’s risk profile and ensures patient safety.
Board Certification Verification: If a healthcare professional claims to be board certified in a particular specialty, credentialing services verify this information with the relevant certifying board. Board certification indicates that a provider has demonstrated expertise in a specific area of medicine beyond the basic licensure requirements.
Ongoing Monitoring and Re-credentialing: Credentialing is not a one-time process. It involves ongoing monitoring to ensure that healthcare providers maintain their qualifications and adhere to professional standards. Periodic re-credentialing ensures that providers stay up to date with their education, training, and licensure requirements.
Provider Enrollment: Credentialing services also assist healthcare providers with the enrollment process with insurance companies, Medicare, Medicaid, and other third-party payers. This involves completing and submitting the necessary applications and documentation to become an approved provider for reimbursement purposes.
The Credentialing Process takes anywhere between 1-4 months which can prolong to 1 year if it was not done properly, once you are approved from credentialing the next phase is Contracting which takes anywhere between 15-45 days.
It is the most hectic process that involves multiple application forms to be completed & submitted along with a number of documents.
There is no similarity in credentialing applications when it comes to different specialties, each specialty has different standard procedures.
Why Stars Pro Credentialing?
When it comes to medical credentialing, Stars Pro understands what it takes to deliver results. With a vast experience of working in the healthcare insurance industry, we are confident that we can enroll your practice with top healthcare insurances of USA.
We are better because of the following:
- Free Consultations
- Free NPI Registration
- Free CAHQ Registrations & Updates
- Initial Submissions within 24 hours of your signup to expedite all your applications
- 99.9% Clean Submissions
- Timely response to insurance companies to avoid rejections
- Monthly CAQH Attestations to avoid delays
- Contract Negotiations to get you better Rates
- Consistent follow-ups that enhance Credentialing processes
- Real-time Reports that keeps you up to date with your statuses
Our Credentialing Services
- Initial Credentialing & Enrollments
- Re-Credentialing
- Contracting & Negotiations
- Licensing & Renewals
- Malpractice Insurance Enrollments
- DEA Registrations
- Demographic Updates
- Hospital Privileges
- IPA Enrollments
Specialties We Handle
Stars Pro provides complete physician credentialing services adhering specialties to guidelines determined by state regulations, private and government payers, and hospitals.
EDI/ERA/EFT Setup
We can assist you in setting up your EDI/ERA/EFT setups with different insurance companies for electronic claims submissions, rejections, eligibility, payment information, denials, and electronic fund transfer.
Re-validation
Credentialing is not Just one time Job, Almost every insurance requires you to file your re-credentialing Or Re validations within a set time frame We make sure that you don’t miss a single notice that can cause your payment to be delayed or even Contract Termination. We know exactly when you are due for Re-Credentialing or Re-Validations and we file it before you know.
