Most practices are not equipped to handle the basic provider enrollment or contracting needs of today’s healthcare environment.

If you are a new start-up practice, we can help get you on the right track from the beginning. The credentialing process and payer enrollment will ensure that you are ready to begin your practice. From starting your corporation, getting your Medicare and NPI numbers, to getting you contracted with the numerous managed care entities, we take all of the steps needed to get you going. Let’s go over some of the main points of credentialing.

What is Provider Credentialing in Houston, Texas?

Provider credentialing is a controlled procedure for determining a provider’s qualifications. 

Different providers including physicians, dentists, and other allied healthcare professionals must demonstrate that they have the necessary education, training, and licenses to offer patient treatment in order to pass this crucial safety check. Prior to adding a provider as an in-network provider, hospitals and health plans check the information they have been given by the provider.

This credentialing procedure is also mandated by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) and the Centers for Medicare and Medicaid Services (CMS). Before a provider is qualified for Medicare or Medicaid reimbursement, CMS demands it. In addition, the majority of hospitals work to get Joint Commission certification as a sign of their dedication to provide high-quality treatment.

How Does the Credentialing Process Work?

There are several steps in the provider enrollment and credentialing process. A provider has to complete this process with every health plan they want to enroll with.

  • The doctor provides all necessary information, such as contact details, a current resume, education and training histories, licenses and certificates, connections with medical groups and hospitals, Board certifications, sanctions or history of malpractice, evidence of liability insurance, and peer references.
  • The insurance company or provider organization verifies that all the data is accurate and current.
  • If no issues arise, the provider group or health plan grants the provider a certification.
  • The time it takes to complete the physician credentialing procedure might range from 30 days to six months or longer, especially if the material is sent through fax or mail.

How to Ensure That Your Credentialing Practice is Healthy

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.

Adopt a Strategy of Standardization

Healthcare organizations need credentials as soon as possible and one way to do this is to start with standardized “core privileges” for each specialty’s scope of practice to simplify the process of establishing what each provider can perform.

Embrace Technology

Some medical staff services departments still rely on paper files to keep track of licenses and certifications. Advances in technology have made it possible to easily capture and store the information needed for credentialing.

Centralize Your Approach

Systems with multiple locations often make things hard on themselves by requiring a different medical staff application for each facility the provider will be working at. Credentialing processes can cover the same ground several times by asking for the same information or checking with the same sources.

Credentialing and Payer Enrollment in Houston, Texas

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. Contact us and learn how our services can help your practice.

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