6 Best Tips for Simple, Accurate, and Successful Provider Credentialing

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Credentialing is the foremost important step for any healthcare provider organization before it can start billing an insurance carrier. It is an essential means of getting on insurance panels and networking with various insurance companies.

In the modern healthcare industry, it is the responsibility of all medical practitioners and healthcare providers to ensure patient safety while delivering high standards of medical care. While it is highly important to employ qualified and experienced medical staff for ensuring high patient outcomes, all healthcare institutions must have medical bylaws that highlight credentialing and privileging methods and requirements to prove the competency of the entire medical staff onboarded.

In the past, only hospitals were allowed to perform medical credentialing, but it is mandatory for all healthcare facilities to get credentialed, today. Various healthcare providers including chiropractors, counselors, and even massage therapists, who were running a ‘cash only’ practice, now must get credentialed to accept their insurance for payment.

Through medical credentialing, healthcare providers can not only get assessed for their qualifications and competency but also can bill an insurance carrier. However, the entire process can be extremely tedious, which triggers providers to commit serious errors in their applications, and eventually, they face rejections.

Here are the six most important tips for healthcare providers and medical practitioners to ensure quick, accurate, and successful outcomes of their efforts in the provider credentialing process.

1. Start with Writing a Good Provider Credentialing Application

The utmost important part of the medical credentialing process is a good provider application. Being the very first step of the process, ensure that you are writing correct data about your personal information, qualifications, and about your practice. Your provider application must also include all your professional credentials and professional experience.

Don’t think of writing an application for provider credentialing as an inquisition; it is a required process for you to ensure complete accuracy while getting you credentialed. It can sometimes be frustrating to keep an eye on the correctness of your data. In most cases, hiring a credentialing coordinator or outsourcing credentialing services can help you write a good application and keep your data updated throughout the entire process.

2. Assess and Verify all the Data Given by Healthcare Providers

After you are done writing your provider application for your provider credentialing, you must ensure that there is plenty of time to verify that all the information provided is accurate and valid. After all, medical credentialing is a process that investigates your providers’ professional and financial history, and in recent times, social media history as well.

Hiring an experienced credentialing service provider can help you get all your information as well as references in your provider credentialing application verified. This step is vital as it ensures that your application is not rejected after months of putting in a lot of effort into the process. Key elements in your provider application to verify include board certifications, medical licenses, and sanctions.

3. Ensure that all Providers Understand the Requirements

It is necessary for all your healthcare providers to understand that medical credentialing is an indispensable part of modern medical practice. Credentialing must be performed to ensure that your medical staff and healthcare workers, who are actively offering their clinical services to your patient, are qualified and competent to do so.

While there are cases reported where healthcare workers with false experience and invalid certifications were practicing medicine, and strict action was taken on the respective healthcare institutions. Thereby, train your providers to understand the importance of medical credentialing, so that they can provide specific pieces of accurate information about their educational and professional history.

4. Allow Plenty of Time to Complete Your Provider Credentialing Process

The entire process of provider credentialing involves a multitude of bylaws that must be followed by medical institutions. Various steps in the provider credentialing process include pre-application screening where many applications are rejected on various grounds. Thereby, it is always better not to haste the credentialing process and ensure all the details are correct and accurate.

This entire operation requires plenty of time. You must understand how long it takes for credentialing in optometry and plan your entire timeline. Know that provider credentialing is not only time consuming but also a critical process, which deserves to be given the time it requires.

5. Investigate Malpractice Claims Early in the Process

Malpractice liability certification is a crucial part of the process of medical credentialing. You must spend a good amount of time investigating malpractice claims as a part of your provider credentialing process. In cases where information about malpractice claims have been avoided in any provider application, it directly reflects in the raising of red flags that may attract more investigations.

However, it is important to understand that the presence of malpractice claims does not directly signify that the healthcare provider is not eligible to get credentialed. This simply means that you will have to perform additional investigations and scrutiny of that particular provider application.

6. Send Your Application for Review to Avoid Rejections

Once you are done with writing a good application, which has correct and updated information about our providers, please thoroughly review all the details by yourself. Keep in mind that there is much more in the process than to send your credentialing application and wait for approvals. Apart from ensuring accuracy in your applications, you must also keep an eye out to decipher hidden costs of medical credentialing.

It is usually the best practice to outsource a credentialing service provider to review all your applications and quickly make changes in order to avoid rejections in various phases of the provider credentialing process. CSEYE is a leading credentialing service provider in the optometry space. Get in touch with us, and our experts can take the burden of credentialing off you and save your time and money.