All you want to know about Credentialing
The meticulous review process of the qualifications of licensed medical professionals and obtaining their validity and background is known as Credentialing.
A large number of healthcare institutions as well as network providers make their own credentialing. It is done either by an electronic device or through a credentialing specialist. But after the credentialing, it should be reviewed by a credentialing committee.
The Credentialing may include allied health staff members. It may also involve granting or reviewing specific clinical privileges.
Some of the common misconceptions about medical credentialing that cost time and money are as follows.
- Relying on limited staff and administration:
Healthcare credentialing is a complicated process that involves various kinds of minute detailing. These include precision, detailed attention and patience.
Moreover, there is a long list of certifications and licenses that are needed to be verified. For every individual healthcare provider, all this information must have to be checked and tested carefully.
All the healthcare providers, especially the doctors and nurses, must be appropriately credentialed. The previous work experience and qualifications must have to be checked so that there should not be any misconception.
Sometimes due to some misconceptions, the administrators make mistakes, and that is the reason why the insurance provider does not accept the applications.
The reimbursement process delayed for this. Moreover, if due to a misconception, any staff makes a mistake regarding licensing or criminal background checks, it can seriously damage the hospital’s reputation.
- Sending incomplete provider enrollment applications:
A sufficient amount of information and data is required in the standard provider enrollment application. If there is an error while filling the credentials, there might be a misconception, and it causes a delay in reimbursement and potentially denied claims.
These misconceptions are unfortunately inevitable and can cause a delay in the work.
The company’s database is merged with the matched data, and then, the application process begins. This entire automated process is swift, but it can be delayed if there is any misconception.
- Not updating and verifying information:
Renewal of all these credentials and licenses of every individual is very important regularly. If the credentials and grants are not refreshed and routinely renewed, then it can lead to a misconception. It should be up to date with the licenses and other documents.
Due to all these, hospitals fail to stay on the top of their medical credentialing. Information is updated for verification every 90 days by the Advanced Health medical credentialing services.
- Fake or Duplicate Credentials:
It is noticed several times that due to submission of fake credentials during the time of recruitment of individuals in the various medical services, many accidents and deaths of patients occur. Deaths are mainly due to improper treatment by doctors or nurses.
Then different wrong notions or misconceptions come into the mind of the patient’s family members. So proper verification of credentials with the original documents is one of the prior requirements before hiring or recruiting an individual in the health service.
- Improper Treatment:
Misconceptions may arise about the qualifications or the degree of the doctor during the time of death of a severe patient. But that does not always occur due to the fault of the doctors. In maximum cases, this is caused due to the unavailability of money and medicines too.
Medical credentialing can be time-consuming and expensive. If you don’t have expert staff, it can take weeks or even months to complete the process, resulting in significant revenue loss. Partner with us & enjoy top notch credentialing services at absolutely no costs.