Tips for a Successful Medical Credentialing Process

Credentialing is one of the most crucial processes when it comes to the healthcare industry. The process is in place to regulate and streamline healthcare professionals’ credentials, such as licenses and registrations.

The significance of medical credentialing arises from the potential impact on patient safety and the legal repercussions for employers, healthcare facilities, and other providers.

If you overlook the importance of the provider credentialing procedure, you will have delayed cash flow. Today, credentialing becomes paramount when healthcare practitioners aim to ensure that best practices are in place to provide speedy, productive results.

The entire process is a little complex. It involves a thorough background check of the provider in terms of financial & criminal history and, increasingly, their social media behavior. The process is long, so every provider has to warm up accordingly. Here are some quick tips that can help Fast-track the entire process.

1. Start early

Begin your credentialing procedure as soon as possible. Begin by gathering reference documents, CVs, updated contact information and records, and all other necessary material. Because the medical credentialing procedure is time-consuming, it will likely influence your cash flow and reimbursements.

While most businesses would tell you that 45-60 days is more than enough time to start and finish the procedure, this is not the perfect way to proceed. Therefore, we propose you begin your process in advance to provide enough time to complete it effectively.

2. Conduct an early background investigation on your own

Before issuing an employment offer, many practices do background checks on new physicians. It includes verifying training, licensure, and employment history. It may appear to be overkill, but it can prevent employing a physician only to run into licensure issues later.

3. Keep your information up to date

Ensure your office manager or credentialing coordinator has accurate and up-to-date contact information. Dealing with credentialing or re-credentialing issues can take longer than necessary without direct communication. The credentialing procedure also entails submitting several forms, and good communication is crucial.

4. Get a thorough understanding of the state’s regulations

Understanding how credentialing works can significantly impact how smoothly a practice runs and how quickly income flows. Your state may have legislation regarding physician credentialing and reciprocity agreements with payers and other state credentialing bodies. If you are enrolled with a payer in one state, the payer can expedite your credentialing in another.

Credentialing issues may be costly and drain productivity, so it’s critical to have a process and a plan in place to ensure credentialing is constantly up to date. You might check into professional medical credentialing services to handle the process for you.

5. Get a credentialing coordinator

Providers are busy. Their schedule is already hectic, and following up on a complex process can be frustrating. One of the most efficient ways to deal with credentialing is outsourcing. Outsourcing allows providers to have a dedicated assigned coordinator who will step up and stay on top of the deadlines and expirations.

How Can Capline Healthcare Management Assist You With Your Credentialing?

We are here to assist you in more than one way if you require assistance with medical credentialing.

• Before submitting applications to the payer, our professionals will collect and analyze all essential documentation to assure its completeness and accuracy.
• We can assist staff and providers in reducing the time-consuming activities of enrolling and re-credentialing with both government and commercial payers.
• We ensure that all providers are credentialed on schedule to avoid payment delays or reimbursement loss.
• We have maintained strong relationships with thousands of payers throughout all states and handle all communication and follow-up until applications are approved.