Have you considered physician credentialing services? Why is it so essential for healthcare professionals? Well, physician credentialing is definitely a must have service especially for healthcare professionals or physicians or medical practitioners. Generally most of the healthcare organizations and provider networks conduct their physician credentialing services with the help of a credentialing specialist.

Recently, outsourcing physician credentialing services has become a growing and evolving trend as it cuts down the operating costs from 30-40%. It works as a key area for healthcare professionals or physicians who require credentialing services benefitting their revenue payments. Physician credentialing services actually depend on credentialing software. Usually it’s two different jobs where the physician has to invest for both. But, when certain outsourcing physician credentialing services provide both credentialing services as well as a dedicated software, it’s a double bonanza and a must try!

What is Physician credentialing service?

  • Healthcare professionals or Physicians including hospitals and other healthcare organizations will have to undergo physician credentialing process to bill with insurance companies and receive timely reimbursements for the services rendered.
  • Generally credentialing process involves obtaining, verifying and also assessing the provider or physician qualifications to healthcare organizations. It serves as an evidence of documentation including license, education, training, experience as well as other qualifications required to deliver better services and avoid fraudulent practices.
  • Physician credentialing services are very crucial because it’s the procedure which allows patients to trust their chosen healthcare professionals and be confident in the services they obtain.

How long will Physician Credentialing process take?

  • There can be many reasons for physician credentialing services to consume time and it depends on the documentation history of the physician. It involves shorter period of time if the physician is already enrolled in a healthcare plan. It takes longer days if the physician has not completed any credentialing with insurance companies.
  • It takes shorter period of time if the physician has practice group tax ID and provider contract. Depending on these requirements, it takes 60-80 days for physician credentialing process.
  • Successful completion of physician credentialing depends on the unique scenarios, as per the documentation history.

Why is reappointment application needed every two years if the information remains the same?

  • According to the State law, accreditation bodies and Quality Assurance, it’s essential for healthcare professionals, practitioners and medical staff to get evaluated by means of performance, licensure, clinical competence and activity once in two years.
  • In case the current appointment expires, it takes an average of four months for the entire reappointment process to complete; from receipt to final approval. It’s also important to check if applications are processed within the time frame of the physician’s current appointment, as it’s necessary to mail 180 days in advance and receive them within 30 days.

 Whom should the provider contact to change current physician credentialing services?

  • In order to change or review current physician credentialing services, healthcare professionals or physicians can contact the credentialing services company’s coordinator who would assist in completing appropriate forms.
  • There can be certain norms to complete or shift the current credentialing services. The physician is responsible to ensure if he/she is aware of these norms to complete the current credentialing services and shift to another.

Why does the physician credentialing process take long time?

  • The physician credentialing process depends on the requirements of primary source activities starting from the medical school. It takes into account responses for the queries regarding training, experience, affiliation, licensure and malpractice, if any. The application must be filled with all the proper details including specific dates, address and contact number.

What is primary source verification in physician credentialing services and why is it necessary?

  • For physician credentialing, the provider or the applicant will be evaluated depending on the training, education, license from primary sources for hospitals to verify the information mentioned in the application.
  • The information provided on the application is cross checked with the primary source. Additional information might be requested for further processing but primary source remains constant to verify the accuracy of information provided.

How can the Physician credentialing process be expedited?

  • The first and foremost duty is to fill the application accurately without any missing information. If the information is not accurate, it causes huge trouble for the hospital staff to recheck the correct information required for physician credentialing services.
  • The responsibility of providing accurate information lies with the healthcare professional or the applicant.  An applicant should be certain about professional reference with respect to knowledge on their current clinical competence, work ethics, health as well as the ability to coordinate and work together with others.
  • Specialty must also be included in one of three references.
  • The physician or the applicant must also provide the information on previous affiliations, training programs and also a complete history of professional liability coverage for the past 10 years.
  • Any gaps in time should be informed in advance with proper explanation.
  • Remember to return the application before the deadline by allowing sufficient time for credentialing process.

Where can Physicians credential their services?

  • Outsourcing physician credentialing services can be the best option for healthcare professionals and hospitals. Credentialing services accompanied with credentialing software is an added advantage with reduced cost and time compared to in house credentialing services.
  • Few outsourcing physician credentialing companies offer lower rates with professional services accompanied with a software. Healthcare professionals need not search for any software elsewhere as it serves as a one-stop solution.

What is CAQH and why is it important to healthcare professionals?

  • The CAQH is a Universal Provider Data Source which is designed to simplify and accomplish easy administration by gathering credentialing data in a single repository that can be accessed by healthcare professionals participating in health plans and other healthcare organizations.
  • Its main objective is to simplify the physician’s credentialing data gathering process and make it easy for healthcare professionals to update their information or details without any hassle.
  • Physician credentialing services involves a lot of time and effort to complete the paper work. CAQH reduces the effort and time for the process.

Can any Health Plan access data of healthcare professionals?

  • It’s a big No! Healthcare professionals can control their access to the plans that has sensitive information. On completing the application, physicians will be indicated to participate in the plans in which healthcare organizations will be able to access their data.

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