Why Medical Credentialing Is Important

You know what medical credentialing is – but why is it so important?

Medical credentialing is obtaining and evaluating documentation for a medical provider in order that they can participate in a network or treat patients at a medical facility or hospital. It’s essential for medical offices to be able to partner with insurance carriers including Medicare and Medicaid. In the absence of providing verifications to these organizations, physicians and other medical professionals may not be eligible for reimbursable expenses.

Providing Required Credentials

Insurance carriers and medical facilities have their own specifications for medical credentialing. In general the following credentials will be required:

· Provider application
· State license
· DEA license
· Board certification
· Hospital affiliation
· Training
· Education
· Malpractice insurance certificate

When a provider requests in-network status, the insurance companies perform primary source verification on all providers to ensure they are qualified to be in the carrier’s network. Primary source verification means that a provider’s information is verified by the person, organization or body that actually issued the information and therefore has direct knowledge of its legitimacy.

At 1st Assistant when we send provider applications to insurance companies, they perform primary source verification according to their standards. We then follow up to ensure that nothing more is needed to evaluate the information and therefore confirm the timely processing of the file.

Why Timely Credentialing Is Important

It is risky to let a medical professional perform services without proper credentialing. The process of credentialing protects the patients in the facility as well as the members of the insurance companies. The number one reason to do credentialing is for the safety of every patient who seeks medical attention from that provider. The insurance companies and facilities want to ensure that the patient will receive the highest level of care possible from their providers.     

Timely and proper credentialing means that only those healthcare professionals who have gone through rigorous evaluation regarding their qualifications to practice medicine will treat patients. Knowing that providers have been vetted and monitored allows for public confidence in the organizations’ decision to permit doctors to practice in their facility or to be promoted by an insurance company in its directory.

Are you still doing credentialing within your administrative staff? Give us a call and learn how our dedicated specialists can take over this tedious and time-consuming task quickly and professionally.

Let Us Manage All Your Payer Enrollment and Credentialing Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, Vice President of Credentialing, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.