What Is Credentialing in Healthcare? 

Not everyone can be a medical provider. You need to hold specific degrees, training, certifications, and other proof that you are able to practice medicine. Credentialing is a process that verifies you are competent and trained to provide care to patients seeking medical assistance.

Credentialing also establishes guidelines and frameworks to ensure that each patient receives the highest level of care. That way, all healthcare workers must adhere to the same standards, and all institutions must provide a necessary level of care and patient security.

Read on to learn more about medical credentialing and why it is so important.

Credentialing Basics

Healthcare organizations need to verify the competency and credentials of each medical provider to ensure they have the necessary skill set to provide an adequate level of care. The process is also called provider credentialing, doctor credentialing, medical credentialing, or physician credentialing. 

The process typically refers to authorizing physicians, but similar systems exist for other healthcare workers like nurses. However, these processes may be a little less rigorous.

Credentialing is a complex process that takes a long time. In order to confirm all necessary information, a regulatory body may need to contact medical schools, licensing boards, and a range of other healthcare organizations. That’s why this process usually takes several months, but sometimes you may have to wait for over six months.

Who Is in Charge of Credentialing?

Certain entities like the Joint Commission on Accreditation of Healthcare Organizations and the Federal Centers for Medicare and Medicaid Services (CMS) set regulations and requirements for medical practices. If you wish to be eligible for Medicaid and Medicare reimbursements, you need to become credentialed, so all healthcare practices go through this process.

Other organizations like The Accreditation Association for Ambulatory Healthcare (AAAHC), Utilization Review Accreditation Commission (URAC), The National Committee for Quality Assurance (NCQA), and others also provide accreditations.

Doctor credentialing is typically performed when a healthcare professional enters a medical practice, which requires background checks. In addition, provider credentialing is done when a medical facility applies to become a part of a health insurance network. That insurance provider must then authorize the practice and everyone involved.

What Are the Steps of Medical Credentialing?

A credentialing process usually goes through three phases:

1. Information Gathering

During this phase, a practitioner must submit information about their education, background, training, certificates, work history, and other relevant information. The required documentation and information vary depending on the accrediting institution. However, you’ll need patience and time to gather everything.

2. Information Check

Once you submit everything they asked for, the organization will need to do background work. These institutions usually have systems set in place to make contacting and authenticating your information more manageable. However, it still takes a long time because there is so much information to verify.

3. Awarding the Credentials

Once the process is over and the organization verifies everything, you’ll receive your credentials. However, don’t be surprised if you have to wait for months for that to happen.

Where to Find Professional Help?

If you need assistance with credentialing or any other part of healthcare management, Peregrine Healthcare can help. With our extensive experience and dedication, our services are guaranteed to free up your time and let you commit to your patients while we take care of the paperwork. Click here to contact us for more details.

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