Credentialing Essay

694 Words3 Pages
Credentialing is important to the healthcare sector in many ways. It’s the way/process in which is used to evaluate the qualifications and practice history of a physician. In the process of physician credentialing they must provide pertinent information/documents like their complete educational training, residency, and licenses. They should also include any certifications by a board in the physician area of specialty. Provider credentialing is more than just another form to fill out or a minor nuisance; it’s a complex, ongoing process and a critically important one at that. Without successful credentialing, provider reimbursement for medical services can be delayed and, even, denied. Given its many steps, critical deadlines and lurking…show more content…
Credentialing, in general terms, is a verification of your experience, expertise, interest and willingness to provide medical care. In broad terms, credentialing encompasses obtaining hospital or facility privileges, as well as successfully enrolling in health plans as a participating provider. Even after submitting the myriad documents and forms to a variety of third parties to verify your credentials after joining a practice, don’t think that you are done. Even though most facilities and health plans do not require a full re-hashing of the credentialing process, most oblige you to submit annual updates. In other words, credentialing doesn’t stop after the initial forms are submitted. You’ll find that the process consumes hours and hours each year, particularly if you’ve adopted an inefficient Several states have their own laws for timely credentialing, including reciprocity regulations (if a physician is credentialed in another state by Anthem, for instance, her credentialing in your state can be streamlined) and in-state credentialing (a physician moving from one practice to another within the same state does not go through the full credentialing process again). Contact your medical society or state Medical Group Management Association to ensure you are using your state's standards to your
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