How I Achieved Maximum Success with Credentials

Things that You Need to Know Regarding Physician Credentialing

The physician offices, hospitals as well as managed care insurance companies and the different laboratories all credential the physicians. You have to know that credentialing is actually the act of gathering information about the doctor or medical provider to verify their qualifications when it comes to practicing medicine in their specialty.

Know that there are many agencies which actually oversee the credentialing processes. There is a leading agency which monitors the credential and also the qualification standards in healthcare. It is necessary that the medical providers undergo the credentialing process before they are hired by the insurance companies or the medical facilities. Know that physician credentialing or medical credentialing is going to verify education, training, licensure, quality and also the general ethical standing of the provider in a medical community.

The credential process of the doctor would start with the medical provider submitting information to such credentialing agency for evaluation. The areas of focus would include the licenses, education, board certification, background check, malpractice claims, resume and the detailed work history, privileges, personal preferences, the malpractice insurance and several others.

The information is collected and then reviewed by a certain physician peer-review committee. Such committees make recommendations to the professionalism as well as the standing of the provider in the medical community. The physician’s ethical behaviors would also be evaluated by the committees.

The insurance companies would include the government-sponsored payers and they will look for the medical credentials of the physician before they would accept the professional into the participating providers. Those physicians that didn’t undergo credential procedures won’t be allowed to bill for services according to the policies of the Medicaid and Medicare. Managed care organizations do have such strict physician credentialing process before the provider is listed as participated with the insurance company. A lot of private physician credential the doctors to guarantee quality care delivery.

Know that provider credential is one way to assure the consumers that the medical providers have been reviewed by the peers. Such would provide much higher level of trust and make sure that the provider is licensed as well as certified and hasn’t had the licenses or privileges revoked by another state. But, such cannot determine the quality of the care offered by the provider. So many credential committees implemented policies that the providers must participate in like periodic credential updates and reviews to keep the status current.

There are a lot of companies, such as medical practice consultants, specializing in the provider credentials. Such companies would consult many medical facilities and the provider practices in order to monitor and guarantee that the physicians’ credentials are current.

Cited reference: my review here