6 Mistakes To Avoid As a Medical Credentialing Company

Medical errors are the third most common cause of death in the US and perhaps one of the leading causes of death across the globe is a nightmare for any healthcare facility.

So how do they avoid it? To ensure quality healthcare, the quality of the healthcare provider must be ensured. That is where medical credentialing comes into play.

What is medical credentialing?

Medical credentialing is a process that helps to verify the educational qualifications, training, and practice history of a physician to conclude if they must be hired or not.
Medical credentialing is as mandatory as beneficial. However, there are some common mistakes to avoid when you’re seeking medical credentialing so that you do not end up in revenue loss.

1. Being unprepared for delays:  

Medical credentialing service is a time taking process as it involves the collection of documents and their verification. It usually takes at least 3-4 months and, at times, even more. A healthcare facility must keep this in consideration. If credentialing is delayed, the Physician to be credentialed has to wait to start rendering consultation to their patients. It is both a waste of time, as well as money. Hence, before you start the credentialing process, take a practical estimate of the time that might get covered up in the process.

2. Typos in data or incomplete information:

Make sure that the data you provide to insurance credentialing services or directly to an insurance company is accurate, and cross-check for typos and missing information. Any kind of incorrect data or missing information will only work to delay the process of credentialing.

3. Error in application:

If any part of your application is left blank, or if any piece of information is missing from your application form, the application gets rejected. Likewise, if the application form has not been signed or attested by the right person, it gets rejected. Hence, rechecking your application form before submission reduces its chances of rejection and does not cause extra delay.

4. Being unaware of the regulations:

When dealing with an insurance provider, let a trained person handle it. Even the slightest ignorance on your part could end up in chaos. Every insurance company has different criteria for credentialing. Be completely aware of the demands of your insurance company to comply better with the insurance company and the legal implications.

5. Rushing into the enrollment process:

The enrollment process has a direct effect on your revenue cycle. The application form must be able to satisfy the criteria of the insurance company. If you’re new to the area, make some connections before trying to get into a panel of insurance companies in that area. Also, assign a team to especially be in contact with the insurance companies to answer their questions and queries.

6. Being uninformed about the latest changes in credentialing process

Government and private insurance companies keep modifying their credentialing process from time to time. You must keep yourself updated with all the latest information regarding the credentialing process and the criteria. Not being aware of the latest developments in the credentialing process increases your chances of rejection and, in turn, takes a toll on your revenue cycle. Hiring a medical credentialing specialist or outsourcing the service can be of great help here since you receive assistance from experts.

Medical credentialing is a complex and time taking process. There is a multitude of factors that could cause you rejection and end up harming your revenue cycle. To ensure timely credentialing, make sure you plan well, keeping in mind all the factors that could cause a delay. Assign a team to contact the insurance company and answer their queries. Make sure that your application form is taken care of by trained professionals. Keep yourself updated with all the latest information on the credentialing process. And finally, ensure that you comply with all the regulations of the state where you’re seeking credentialing.

Capline Healthcare Management is a leading provider of medical credentialing services. Our experts offer timely credentialing and take care of all the interactions between you and your insurance provider. Outsource your medical credentialing services with us and achieve a smooth revenue cycle.