The need for provider credentialing services is becoming more critical than ever. Today, more people have health insurance, and they expect their healthcare providers to be in network with their insurance provider. Not being in network puts your practice at risk of losing potential patients to your competition. Here are some ways to make sure your practice is in network with your insurance company:
Verification of a provider’s qualifications
Verification of a provider’s qualifications is a critical step in the credentialing process. It ensures quality patient care and protects healthcare organizations from liability. It also helps ensure compliance with regulatory agencies. It confirms that a provider’s education, license, and credentials are legitimate.
Provider credentialing is a time-intensive and paper-based process that can take more than three months to complete. It requires healthcare organizations to gather information from multiple sources before granting a provider privileges. This information includes the provider’s education, license, work history, fellowships, liability coverage, and eligibility for state regulatory requirements. Credentialing is a must for health care organizations, and if providers are not credentialed, they risk losing payer reimbursement.
Credentialing is an important part of the healthcare process and builds trust between physicians and patients. False or incomplete information can jeopardize a provider’s future employment. Because of this, every detail submitted for credentialing must be carefully monitored. Providers must report any mistakes to the National Practitioner Data Bank (NPDB), which keeps information about malpractice payments, adverse actions, and other healthcare providers. This prevents providers from moving from one state to another without disclosing potentially damaging history.
Steps in the process
There are several steps in the credentialing process, each of which must be completed correctly. Mistakes during the credentialing process can delay the process for both parties. Not only will the process take longer, but it can also affect cash flow. For these reasons, healthcare institutions must ensure the accuracy of their credentialing information. While the process varies from payer to payer, some of the common mistakes can be avoided by ensuring that information is updated and correct.
The first step of the provider credentialing process involves gathering relevant data from multiple sources. The data may include NPI numbers, board certifications, and work history. The information is verified for accuracy through various methods, including information exchange.
Costs
Provider credentialing services can be very costly for your practice. The credentialing process can take up to 20 hours per provider per year, which is equal to half or more of an employee’s salary. Additionally, if the task is delegated to a billing staff member, the workload can become backlogged. This can add to the stress of the practice’s staff.
Fortunately, there are several ways to cut costs. One solution is to outsource credentialing to a credentialing company. This solution can help your practice save both money and time. Many medical billing companies offer credentialing services at a fraction of the cost of in-house services. Outsourcing credentialing can also allow your practice to focus on serving patients instead of completing credentialing tasks.
Importance
Provider credentialing is an important process that allows healthcare providers to become affiliated with payers. This allows patients to use their insurance cards to access medical services, and allows healthcare providers to get reimbursed for these services. It is crucial that healthcare providers get enrolled with as many payers as possible. If they do not, patients will look elsewhere.
The credentialing process involves contacting payers and updating their databases. In addition, providers must be regularly vetted to maintain their affiliations. A credentialing service should also verify provider data in other primary sources, such as the LEIE.
Need for outsourcing
Outsourcing provider credentialing services can be a great way to cut costs and streamline processes. It can also be helpful in reducing errors, which can be costly in the long run. Generally, healthcare insurance carriers take 60 to 120 days to verify provider credentials, but by outsourcing this process, you can save time and ensure that your patient records are always up-to-date.
Providing provider credentialing services can be a complex process. In addition to the technical aspects, organizations need to maintain strict security protocols. In order to stay compliant, all data and documents must be stored and maintained in a secure manner. Choosing an outsourcing provider with strong security measures will ensure the data is secured and protected.
