The Medical Credentialing Process: How Can It Be Simplified? Tips To Follow
In the healthcare system, the medical credentialing process has become an essential part since many patients get insured by the insurance companies for their medical treatment.
The health service provider needs to get reimbursed for the services rendered to the patient. In that case, they need to submit all the required documentation to the payers.
Sometimes the medical credentialing process becomes too lengthy and time-consuming so it is very important for the service provider to understand all the working backgrounds of the credential process.
What Is The Medical Credentialing Process?
A medical billing process revolves around a system in which the health service provider gets reimbursed for the services rendered to the patient by their insurance company.
For this purpose, the insurance company demands some documentation that will approve the credentials of the physician who render the services to the patient.
The credentialing process consists of the verification of the physician’s education, practice, his license, clinical judgment, specialty, and other certifications. All this information will approve that the service provider is credentialed to provide the services.
This information will help the insurance payer to figure out the need for the treatment verified by the physician for the patient.
What Is The Need For Medical Credentialing?
The medical credentialing process fulfills various aspects like verifying that a certain medical practice has a professional physician who is doing their duty with professional certification and expertise.
This will ensure the quality treatment for the patient and this process allows the best and qualified health professionals to operate. On the other hand, medical credentialing also allows the medical practices to get maximum reimbursement for the services they are providing to the patient.
Steps For Medical Credentialing
Medical credentialing is a lengthy process and here are the steps included in the credentialing.
Documentation Process
The medical credentialing process begins with the proper documentation process. As a medical service provider, you need to make sure that you will provide them with full documentation without any error just because vague or incomplete documentation can delay your credentialing process. Also, make sure about the requirement of insurance providers because each insurance provider demands different documentation and form to match the criteria. Here are some details that are usually required for the process.
- Name
- License proof
- Proof of insurance demographic
- information social security number
- specialties
- complete information about the facility which is provided in the hospital and career history.
Prioritizing
Following a medical billing process, you need to make multiple claims because the patient is registered with different insurance companies. In this step, you need to make some rational decisions that will eventually help you out in getting your reimbursement from all the insurance companies.
First, we have to figure out that if your medical billing goes through a single insurance company then make that company your priority and fill their application first.
Also, you have to be familiar with different insurance rules and regulations. Some insurance companies give you an abbreviated application for providers who are already credentialed in a particular area.
Ensure The Accuracy
Make sure that you have entered all the essential details accurately. Here you can ensure the accuracy of your documents by following these steps.
You can verify all the expertise and certification and license detail through various platforms like:
- The American medical association
- American Board of medical specialties
- Office of inspector general
- The educational commission for foreign medical graduates certification and Review of credentialing privileges and insurance claims
Make sure that you submit the documentation with full accuracy without any doubt of error. Because this information is essential for the credential process.
Credentialing Through Automation
Some health service providers gather information for credentialing processes through traditional ways. Such practices will consume a lot of your time and it will further delay the whole process. Now there are many software solutions available in the market which are designed to conduct an efficient credentialing process.
These automation tools will cross-reference resumes and application information through different platforms and verify the credentialing of the physician.
Complete CAQH
One of the prominent insurance companies required The council for affordable quality healthcare conjunction in their application process.
- Whenever any health service provider submits an application to the relevant insurance company then they will give them a CAQH number followed by an invitation to apply.
- You can complete the CAQH form in both ways through an online platform or manual writing in paper form.
- Make sure that you give them inaccurate information because any error can delay the whole process.
- In the last step, you have to prepare a re-attestation. It is an essential step that ensures the continuous eligibility of insurance.
Following Up
When you have done all the required documentation then the last step is to submit your application to the insurance provider. It is considered a lengthy process and it may take from 90 days to 120 days. But you need to follow up on your application timely which Brightens the chances of early approval.
Call each insurance company every week to get the status of their application. In this way, you can get to know the status of your application and if there is additional information or any missing document required so you can give them instantly rather than waiting such a long time.
Recertification
After completing all these steps you will finally get the credential from the insurance company. But you can’t say that this process is finished while credentialing is an ongoing process and credentialing is required every three years. The credentialing software in that way will notify you of the renewal of the documentation.
Need Help?
As we know that the medical credential process is not simple and it can consume a lot of time of your practice and if you get disapproval from the insurance provider then it may take more time of your practice. Outsourcing is the best way to save time.
Med-Miles can give you an opportunity to get a quick credential of your services. As it is a tricky process and rules and regulations vary throughout the year.
We assured the submission of clean and correct applications and minimize rejections and elimination of your applications with the help of a dedicated follow-up team. Call us at(888) 598-9181 for further information and details.
