OVERCOMING STUMBLING BLOCKS IN CREDENTIALING SERVICES

The credential process is one of the most complex and difficult procedures in healthcare institutes. This process is not a one-time process, but it requires regular attention. The process of credentialing is necessary for practitioners, therapists, and nurses. Literally, credentialing is essential for everyone who works with patients in a healthcare institute. 

Because of the complexities involving this process, companies are coming up with credentialing services for providers. This enables the practitioners and other workers to fulfill this process with ease. The insurance providers or the payer verifies the details submitted by the practitioner before providing them the credential certificate. 

The credential process is essential for the practitioner to prove that their practice meets the minimum requirement set up by the medical standard. Apart from providing a confidential view to the patients, which ensures frequent and repetitive visits from patients. 

Although credentialing services are essential, this also proves helpful in other processes as well. Credentialing helps in improving visibility, thereby helping in getting new clients. Patients consider it convenient to visit healthcare with credentials. This is because of the trust level of these institutions. 

NEED FOR CREDENTIALING 

Enrollment services provide multiple advantages for both the patients as well as the practitioners. A few of these advantages are – 

Confidence in patients – 

The credential services provide adequate confidence to the patients. This instills faith in the patients. They see the credential certificate and start trusting the physician completely. This will ensure a quick recovery and lower the questions asked. 

Professionalism – 

The credential certificate showcases complete professionalism. The systematic process of data gathering, primary source verification, and assessment display the experience and merits of healthcare. The credentialing certificate display authenticity of the physician as well as the institute as a whole. 

Compensation –

The medical credential is essential to get timely reimbursement. Timely documentation provides new nurses and doctors to start with their services right from the first day. The medical insurance companies will ensure that the practitioners have proper enrollment before they have actual interaction with the patients.

Minimizing Errors –

Credentialed staff have the ability to contribute to the overall performance of the healthcare institute. Errors in the medical field will have fatal results. It is therefore necessary to make sure that healthcare workers make no mistakes.  Minimizing errors also means a very low denial rate. Having a low denial rate keeps the revenue flow of the institute steady. 

ISSUES ARISING DURING THE CREDENTIALING PROCESS

The credentialing services involve a minimum of 60 days. The process requires at least 41 days for enrollment. Any errors in the form or failure to show up for appointments will elongate this process further. It is essential to understand the following 5 points to ensure a smooth credentialing process. They include – 

Understanding the regulations – 

The most important function of credentialing process is understanding that the process varies from one place to another. It is essential to know the pre-requirements at the place of practice before starting the procedure. Although there are a few states which accept the credentials of another state. Therefore it is essential to understand the prerequisites before starting with the credentialing process. 

Compiling documents – 

After a thorough understanding of the locations, compile all the documents. The credential process requires multiple documents. Incomplete submission or failure to submit all the documents will elongate the process. It may then take more than 150 days to complete the credential process. 

It is therefore essential for understanding the regulations in order to prepare the correct list of documents. Even the list of documents varies from one state to another. 

Submission – 

Pre-application is necessary before the actual submission. The background check will help in eliminating all the medical workers who do not qualify for the credentialing process. The main concentration is on past criminal records, certificates, and other suspensions or expulsions if any. 

After a successful trial with the pre-application, the actual submission is feasible. It is essential to note here that any mistake found after submission will lead to a delay in the process. Make sure to fulfill the below checklist. 

1. Education certificates and other documents.
2. State certification and current license for healthcare
3. Professional experience
4. Personal records of immunization
5. Personal and professional references
6. Affiliations and privileges of the hospital
7. Enrollment with Council for Affordable Quality Healthcare (CAQH)
8. Resume
9. Recommendation letter

This list however is subject to change from time to time. It is essential to ensure that following the latest update from the state where enrollment is necessary.

Following up – 

In such a complex procedure as enrollment, it is essential to follow up with the process regularly. Follow up process is necessary immediately after submission. This will ensure that the application is on track. In case of any missing documents, the immediate correction will ensure minimal delay to an already lengthy process. 

Planning accordingly –

The credentialing process takes at least 6 months. Therefore it is essential to plan and time the process accordingly. Remembering the important dates around the credential process is also necessary. Failure to complete the steps on a timely basis leads to infinite delays. This further adds to the hassles of the physician as they are not able to focus on quality care. 

LOOKING FORWARD

Insurance companies may delay or even deny settlements to practitioners who do not have proper enrollment. It, therefore, delays the reimbursement process. Even the patients do not prefer to visit practitioners who do not have credential certificates. It becomes essential not only for the physician but also for the patients to ensure smooth working in a healthcare institute. 

Although the credential process is long and complex, there are a lot of practitioners who do it themselves. Outsourcing this process to a company will lower the hassles. Studies reveal that patients have more trust in practitioners who have credential certificates. Credentialing provides a sense of security among the patients. 

Companies offering credentialing services for providers have the ability to help practitioners and other healthcare workers get their enrollment. This improves the quality of healthcare and provides patients with options to directly utilize their insurance billing.