By mr euro 
Physician Credentialing is one of the most critical steps in establishing or expanding a healthcare practice. Without adequate credentialing, a provider cannot be added to insurance networks, they cannot charge payers and they do not get payment in return for the care that they provide. A lot of practices are challenged by slow approvals, long paperwork cycles and request after request from payers.” These delays stall incomes, create confusion and are a source of stress for everyone involved in the team.
To bypass these problems, a number of healthcare companies are availing provider credentialing services now. These are services that manage the entire credentialing process, cut down on errors and speed along approvals so your providers can start seeing patients without delay. In this post we’ll demystify the credentialing process, delve into why approvals are consistently tardy and how services that specialize in professional credentialing can speed things up, save time and provide greater accuracy.
Provider credentialing is the process of verifying a healthcare provider’s credentials and competence. Insurance companies require credentialing to ensure a provider is properly trained, licensed, and able to provide safe care of high quality.
Credentialing includes:
- Verifying education and training
- Checking state licenses
- Reviewing work history
- Confirming board certifications
- Completing payer applications
- Updating and attesting CAQH profiles
- Collecting required documents
- Responding to insurance company requests
It’s a detailed, strict process that is different for every payer. Even a slight error can set an application back weeks or months.
“A lot of practices see a delayed process because they’re trying to do credentialing in their spare time or it’s on one staff member,” she says. Here are a few reasons that most waits to be approved are slow:
Payers require lots of documents, things like licenses, diplomas, CVs, malpractice insurance, and background checks. If anything is out of place or expired, then the payer will freeze the process.
Every insurer has different forms and requirements. Mistakes are easy to make and even minor errors can lead to a rejection.
Most payers need an updated and attested CAQH profile. If the profile is not verified or up to date, the payor will not proceed.
Credentialing needs constant follow-up. If a practice isn’t quick to respond to payer inquiries, applications will grind to an excruciating halt.
Payers have long timelines. Without tracking mechanisms, a practice may lose touch with deadlines, expirations and enrollment cycles.
All of these factors delay approvals and prevent providers from working and billing when they should.
Professional credentialing services eliminate these issues using knowledge, seasoned methods and structured procedures. They understand the credentialing process inside and out, enabling them to have applications go through faster and more accurately.
And here is how they help most:
“Every application we are receiving, our credentialing teams have gotten it right the first time. They know payer rules and that every requirement is met. This cuts down on rejections and addresses an e-mail chain back-and-forth that slows things down.
They collect all necessary paperwork from the provider and save them in a neat system. This in turn allows for simplified updating or delivery of documents as necessary.
Credentialing professionals are responsible for maintaining the CAQH profiles current, attested, and accurate. They verify details, upload documents and submit attestations on time.
Instead of corresponding with the payer back and forth or being put on hold, credentialing specialists call payers directly. And, they check in frequently to help move your app along and solve problems fast.
Scheduling Systems What do you track? Credentialing Services have scheduling programs that monitor when expirations are coming due, renewals and re-credentialing dates. They ensure nothing expires, and no application gets overlooked.
With credentialing taken care of by professionals, your team is left free to concentrate on providing patient-orientated care, scheduling and day-to-day operations.
Using provider credentialing services offers practices a number of valuable benefits:
Pay attention for providers to get enrolled with payers quickly, so they can start seeing patients earlier and save money by not waiting months.
Credentialing pros cut down on errors, which often result in lengthy delays or rejection.
Faster approvals result in speedier billing, less denials and greater financial success.
There’s no complicated paperwork, phone calls or email follow-ups for your team to deal with.
When a physician’s credentials are correct, it keeps your practice in compliance and patients, payers and partners trust you.
But the quicker and more precise your credentialing is, the faster you are able to go about running your practice as usual. The longer it takes for providers to get approval, the more time, money and patients you’re missing out on. It also makes scheduling difficult, and puts more administrative burden on the staff.”
Professional credentialing services are there to prevent these types of problems. They expedite the remaining process, minimize errors and ensure all requirements are satisfied. This support enables your practice to grow, remain compliant and give your patients better access to care.
“This could potentially help every type of health care organization, large or small, to get those approvals through faster.” Provider enrollment services have the skill and organization your practice requires to get through the process with no unnecessary hold ups. With the assistance of our credentialing specialists, you can get providers onboarded faster, enact better billing and A/R with performance enhancing reporting to management that relieves stress for your staff, all while maintaining a powerful workflow in the background.
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