What is Medical Credentialing?

Meeting the credentialing requirements of potential insurance payers is essential for healthcare providers to grow their practice. Similarly, healthcare practices should be affiliated with payers to ensure greater reimbursements and provide services to patients. Before moving forward with this discussion, let’s know what is medical credentialing and how it helps providers. So, credentialing is a process where providers or practices affiliate with insurance payers to serve their patients. Once the credentialing is done, the provider becomes part of the insurance network. As a result, physicians are able to perform services to the patients and get reimbursements from payers.

Being a healthcare provider in the US, there is a dire need to drive more patients to your practice. Also, more patients mean more revenue and credentialing helps you do that. In addition, patients trust the practice which is enrolled with maximum payers. As a result, medical credentialing helps you grow your network and provide services to a large number of patients. Therefore, if providers are going to begin a new practice, get credentialed, affiliate with maximum payers, and grow the patient base. So, gain the trust of payers and patients with credentialing and boost your financial growth. Now, let’s understand the process of credentialing with a step-by-step approach.

How Does the Medical Credentialing Process Take Place?

  • The first part to become in-network is to submit applications.
  • Verification of the application before submission helps to avoid errors which may lead to denials from insurance payers.
  • Try to complete all the sections of application to prevent delays and attach all the supporting documents.
  • Provide all the information in the application to make sure that the documentation of credentialing is complete.
  • Consistently follow-up with insurance payers to inquire about the status of your application and make sure payers receive all documents.
  • Make calls, communicate via emails, and visit the payers’ office personally to ensure the approval of application.

Why is Medical Credentialing Important for Providers?

After knowing “what is medical credentialing” and its process, you need to know the importance of this process. In addition, providers need to build a trustworthy relationship with payers to get maximum reimbursements and offer services to patients. Also, running a successful medical practice depends on an efficient credentialing process and meeting the requirements of payers. Similarly, getting affiliated with the insurance payers enables physicians to render services to the patients in the insurance network. Here are some reasons why credentialing is important for practices:

  • Patients trust providers who are credentialed with their insurance network.
  • Healthcare providers can offer services to a large number of patients.
  • Medical practices can get more revenues after a successful credentialing process.
  • The reputation of medical practices improves significantly after affiliation with insurance payers.
  • Medical credentialing with several payers helps providers to increase third-party reimbursements and gain financial strength.
  • Independent practices get a competitive edge over others after going through a successful credentialing process.

Key Takeaways

Keeping in view the complexities of the credentialing process, providers need to focus on accurate submission of applications. Also, insurance companies need all the information related to physicians to verify the details. Likewise, practices need to follow-up with payers to ensure the successful completion of the process. Besides getting an idea of “what is credentialing”, providers should realize its importance for running a successful healthcare business. Further, payers perform primary source verification to check details of physician’s education, license, and other relevant documents. Typically, it takes 60 to 180 days to complete the credentialing process. So, try to avoid errors and omissions in the documentation to complete the process accurately.

After checking the provider’s documents, the insurance payer makes the contract with the medical practice. Now, the healthcare provider can offer services to all the patients enrolled with the insurance payers. As a result, medical practices increase revenue and grow their network to succeed in the competitive healthcare industry. To avoid the hassle of complex medical credentialing processes, reach out to our experts. We offer credentialing services to providers helping them achieve more reimbursements and grow their network. So, begin your practice successfully with our HIPAA compliant customized services according to your needs. Let Physician Billing Company handle the tedious credentialing process and grow your practice.

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