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Provider Credentialing: Why is it Necessary?

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Provider Credentialing-Why is it Necessary

All patients deserve the best care that can be extended to them. One way to instill a sense of confidence and hope in the patients is provider credentialing.  

Credentialing helps to ascertain that doctors and caregivers are certified and possess the requisite knowledge, training, and professional experience to offer healthcare services. It also helps to uphold the highest benchmarks of care and safety in the healthcare industry.

It is also important to note that all data is approved and confirmed by hospitals and health plans before the healthcare provider can be listed as an in-network provider. 

How credentialing works

Multiple stages need to be followed and completed by the healthcare provider with every health plan that one wants to be enrolled with. All the mandatory data such as the CV, contact information, qualifications & certifications, hospital affiliations, etc. needs to be submitted. Once the provider organization verifies the authenticity of the data, the provider is credentialed.

A few reasons for the importance of credentialing for practices: 

All about trust and confidence 

The psychological makeup of patients can play a definitive role in the recovery process. 

Trust in the doctor can help patients feel better about following the doctor’s prescription; be it exercise, diet, a minor operation, or a major surgery. Moreover, patients that have immense trust and bonding with their doctors would stick with them and not keep hunting for alternative practices or doctors. 

Another advantage of having fully credentialed doctors and nurses will help the practice or organization attract quality talent from the competition which can include other doctors, nurses, or even support staff. 

It is the assurance and comfort that potential employees get when they know that their colleagues and peers are updated on the latest news and happenings in the industry backed by their experience, qualifications, and knowledge. 

The mandate for compensation

Getting medically credentialed is a compulsion for receiving any reimbursement from insurance organizations. All relevant documentation for the new hires must be completed at the earliest. 

Credentialing of recruits can commence on the joining day itself. To ensure speed of completion, businesses and practices can request newly appointed doctors or nurses to keep their respective documentation ready for submission when they join the organization on the appointed date. 

This is important because the time required for credentialing can differ across states due to variances in credentialing laws and regulations.

Some health insurance organizations might request a credentialing proof before the teams attending patients.

Adding the professional touch

Professionalism in the healthcare sector can be best outlined by ensuring all documentation is genuine and updated. 

The time spent to complete formalities and highlight credentials is worth the investment as this assures all the patients of the mettle, qualifications, and experiences of the team behind the practice. 

Many healthcare experts used to resist the necessity of credentialing due to the volumes of documentation and paperwork that consumed a lot of time. However, now a lot of time and effort has been saved due to the introduction of online credentialing. 

The availability of data online makes it easier for others to browse through the credentials of the practice even before making an appointment. Hospitals too can verify the credentials of a potential doctor or professional before appointing them as affiliates.

Cuts Down on Medical Errors

A 2018 Johns Hopkins report suggests that about 250,000 people die in the United States annually due to medical errors. 

Hence credentialing is a fair ask for healthcare professionals as it safeguards the security and well-being of the healthcare industry. Patients too must be able to repose faith in healthcare providers and hence credentialing does exactly that.

Maintaining staff levels as needed

 All potential hires need to get working on their credentialing needs right away as this could even take a few months to complete. A bit of compensation or support to help them through the application process could help speed up the process. Tracking the status can also address any bottlenecks in the credentialing process.