How to Ensure a Successful Healthcare Credentialing Process

The healthcare credentialing process is vital for establishing frameworks and guidelines, and confirming that medical providers are competent to care for their patients. Every time a medical facility employs a new physician, nurse, or another healthcare practitioner, they must go through the medical credentialing process to verify their qualifications and approve them with the insurance provider.

Medical professionals must undergo this process every time they begin working with a new employer, even if they have received a stamp of approval in the past.

However, healthcare credentialing can be a challenging and time-consuming process. Here, we give you tips on preparing for medical credentialing, ensuring its success, and finding necessary help for credentialing and payer enrollment in Houston, Texas.

Tips to Ensure Successful Healthcare Credentialing

Making mistakes during healthcare credentialing can be costly and drive down your practice’s productivity. That’s why we give you the best tips to ensure your healthcare credentialing process goes smoothly. Here is what you need to do.

Describe the Credentialing Process to the Candidates Before Hiring Them

You can set up a credentialing process for your practice before hiring somebody. That way, you can notify all applicants about what information they need to provide if hired. That includes:

  • Personal information
  • Proof of licensure
  • Evidence of relevant training and experience
  • Board certification information
  • Other certifications and affiliations
  • CDS or DEA license
  • Malpractice and claim history 
  • Proof of insurance

Perform a Background Check

Performing a background check may seem like an overkill, but it helps confirm that the applicants have provided accurate information. That will allow you to identify potential credentialing problems early on and help you choose the perfect candidate for your practice.

Start the Credentialing Process as Early as Possible

The credentialing process is lengthy, and delays directly impact your reimbursements. That’s why you need to start this process as early as possible and allow extra time for any unforeseen delays. For instance, most organizations tell you that 90 days is enough to go through healthcare credentialing. However, the process can take much longer, sometimes even six months or more. 

Appoint a Credentialing Coordinator

A credentialing coordinator monitors the credentialing process and ensures that your practice submits all documentation on time. Some healthcare facilities appoint this role to one of their employees, while others outsource this task to a professional with more experience. That can speed up the process and ensure its success.

Stay up to Date With the Coalition for Affordable Quality Healthcare (CAQH)

Most payers in the US use the CAQH credentialing program and guidelines. That’s why physicians should regularly update their CAQH profile with the most recent information and changes, which speeds up the credentialing process.

Monitor the Application Status

Once you submit all documentation, don’t just wait around for months to hear from insurers. Instead, you should check in periodically and ask about the application status. That way, you can quickly discover if more information is required and ensure that the application moves along promptly.

Hire a Healthcare Credentialing Services Professional

Medical credentialing can be hard to implement and consume a lot of time you would otherwise spend on your patients. That’s why hiring outside help is a great idea. If you are looking for credentialing and payer enrollment in Houston, Texas, Peregrine Healthcare can help. 

Our focus is to make life easier for all healthcare professionals and practice owners. That’s why we offer various services, including healthcare credentialing assistance. Click here to contact us and learn how our services can help your practice.

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