Why do providers need to be credentialed?

Why do providers need to be credentialed?

Provider credentialing regulates the qualification and ensures the credibility of the provider that the patient has chosen. Credentialing happens at hiring in an organization or adopting a new insurance provider. Hence, there is no room for errors in treatment costs and diagnosis.

It is a quality assertion process to optimize the incidences of dental errors and accomplishes the goal of the best care your patients deserve. In addition, it includes the verification of the provider's education, license, experience, certifications, and residency. Credentialing services assure that the patient will receive the proper care and improve revenue cycle management through receiving timely reimbursement for seeing patients. 

Provider credentialing prevents claims denial and helps expand the patient base by coming on the insurer panels. However, applying and maintaining the up-to-date information with the insurers is a time-consuming process and, if not managed successfully, can lead to revenue leakage, delay in insurance payments, decrease in patient referrals, tedious paperwork, increase in denials, and a not-so-good impression on the payers. 

Significance of Provider Credentialing and Common mistakes in Credentialing 

  • Provider credentialing prevents unnecessary lawsuits against the practice, protecting the healthy revenue cycle as things comply with federal and state regulations. Unfortunately, in some cases, out of sheer ignorance by the staff, lack of awareness of legal jargon, and not being compliant with the standard regulation, things get beyond the control of administrators and providers. 
  • The patients believe in the provider and their treatment. They have the patient's confidence and do not seek competent providers from other healthcare facilities. Credentialing process is time-consuming, and if mistakes happen due to planning can affect the provider and facility equally. As a result, the patients wait before they start consulting, and the insurers cannot reimburse the bill for the rendered services. 
  • In the case of receiving payment from the insurer, it is essential. Otherwise, this can cause fluctuation in the revenue cycle. Credentialing compliance ensures revenue protection. However, not knowing the insurer in the area, not clarifying the multiple queries that insurance companies have before enrolment, or not meeting the timelines pertains to the loss of revenue irrespective of the cause of the delay. 
  • By provider credentialing, your applications look accurate with all the necessary details and documents like proper authorization, no typo errors, or missing information that gives no further reason to the payer to delay credentialing. Poor handling or incomplete applications get interpreted as an ambiguity in the career line of the provider, followed by rejections and prolonging the process further. 

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