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10 Recommendations for a Successful Credentialing Process Flow

If you plan to start your practice or bring new doctors into an existing practice. Your accreditation process must begin well in advance. It is important to understand how accreditation can significantly affect the speed of your cash flow. And how smoothly your practice runs. Ignoring the authorization process will result in delayed cash flow and difficult scheduling due to patient restrictions. Since accreditation issues can be expensive and reduce productivity. It is essential to have a process and plan in place to ensure accreditation remains current.

Recommendations for a Credentialing Process

Here are;

1. Appoint a Credentialing Coordinator:

Whether you outsource credentialing tasks or handle them in-house, appointing a credential coordinator to monitor deadlines and expirations is a wise business decision. They can send out timely reminders to ensure that no one’s credential expires. And refunds are not denied as a result.

2. Create a Sustainable Credentialing Process:

Creating a credentialing workflow can be testing, but it helps in the long run. Your workflow should maintain all required forms and documents, even if you outsource the authorization process. It seems that with a multi-physician practice always comes re-accreditation. And a workflow that accommodates it greatly benefits the practice.

3. Make Use of Advanced Software for Monitoring:

You don’t have to rely on administrative staff to manually monitor your compliance. The cloud-based billing software allows you to easily monitor the status of your credentials from anywhere, anytime. These platforms give you the ability to set up alerts to let you know if a task is about to expire or is due in your RCM cycle.

4. Outsource Medical Credentialing Services:

Medical accreditation can be a time-consuming process. Plus, small missteps in the process lead to frustrating problems later on. Therefore, working with a medical accreditation service provider like Prognosis can be one of the best tips you can follow. When you enter provider credentials using a service like Prognosis. A medical credentialing specialist will review the credentials in the provider registry. Within the organisation and ensure that everything is recorded as it should be.

5. Track Credentialing Applications:

Once authorization requests are sent to the insurance company or organisation, be sure to track the progress of that request. Feel free to contact the insurance company to find out where the application is in the acceptance process. It is not uncommon for payers to delay applications that lack information. Thereby delaying the timely notification of providers.

6. Provide Current Copies of Paper Documents:

For insurance companies that still require paper applications. Your credentialing specialist will need to submit hard copies of licences, DEA certificates, malpractice documents, and other documents, all of which must be current. If some documents are expired or contain incorrect information. This will delay the credentialing process as it takes time to receive and send updated versions of these materials. If some of these documents are submitted to the carriers. This will further delay the process as the insurance companies will then have to redo the new documents.

7. Identify Potential Risks:

  • It is essential to identify potential risks early in the commissioning process.
  • The applicant is not willing to provide all the required documentation.
  • Clinical or coverage gaps.
  • Sudden Termination of License or Privileges.
  • Have short tenures in multiple organisations.
  • An unusual number or history of malpractice investigations or lawsuits.
  • Alcoholism/drugs/domestic violence/history.

If any of the warning elements are present in an applicant’s history. A follow-up interview may clarify the information or a more formal investigation may be required depending on the level of seriousness. Tell the candidate how you plan to proceed in both directions.

8. Stay All Physician Contact Information Up to Date:

The medical accreditation process usually involves various forms of submission. So clear communication throughout the process is very important. Without direct contact, credentialing or credential renewal issues can take longer to resolve than they should.

It’s equally important to ensure that your employees quickly update all important platforms. And channels within your process to correct incorrect or outdated information.

9. Require Peers References:

Our recommendation is to request three peer references from physicians in the same specialty. Who are not current members of the same practice or relatives? If you are going to set these standards for cross-references. Be sure to supply your specifications to applicants for this application.

10. Be Patient with the Credentialing Process:

Credentialing is a long and complex process with many components and steps. You should communicate regularly with your Accreditation Specialist about the progress of accreditation and re-accreditation of your physicians. Make sure you get regular updates and don’t hesitate to ask any questions.

Also Read:

Why is Credentialing So Important?

Medical accreditation is increasingly important because it is the only procedure that allows patients to confidently place their trust in their chosen healthcare providers. RMB credentialing processes offer organisations efficiencies. Reducing the burden on all stakeholders and positively impacting quality. And in the process of verifying that a provider meets standards set by a state, employer, or insurance company.

Why Does It Takes So Long?

Once hired, health professionals cannot begin work at their new facility for several weeks to six months due to credentialing. On the provider side, the process only takes about three hours as they submit around 20 different credential forms. For facility staff, credentialing takes about 20 hours per provider as they perform several tasks that may include:

  • Start a seriousness check.
  • Collect and evidence credentials, clinical reputation, and case histories.
  • Collect and review claims, privileges, and board history.
  • Check penalties with the Office of Inspector General (OIG).
  • Start by verifying primary sources such as the American Medical Association (AMA), medical boards, and educational history.
  • Adjacent files to credentialing committees, executive committees, and facility stakeholders.
  • Create a Bill of Rights and provide a letter of appointment.


Medical accreditation is undeniably important. It ensures that patients receive care from GPs with the correct credentials to give them the highest possible level of care. Therefore, payers undoubtedly make sure that care providers are properly qualified. They do this by following a strict system of checks to look for the correct credentials when submitting a medical application. Even with tips on best practices for medical accreditation, the accreditation process is complicated and time-consuming to navigate. Bringing in an expert with certification experience brings new efficiency to the process.

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