Physician Credentialing Services in 2020

A couple of years ago medical professionals treated credentialing as an optional or unnecessary step to increase their clientele. Nowadays the scenario has completely changed, physicians are emphasizing not only on services but also on credentialing. The process of verifying and organizing professional records of the doctor is termed as physician credentialing in the healthcare industry.

In order to meet guidelines decided by the insurance company (payer), information regarding physician’s degree and education, physician experience, the body of work, liability, licenses, certification, and others would be verified. Physician credentialing is done for the patient’s safety and risk management. Following successful verification, the team from the payer end will accept or can reject the credentialing form.

Physician credentialing is an important step in the revenue cycle, which allows patients to operate their insurance cards for the payment of medical expenses and physicians to get reimbursed by payers for service provides vice versa. However, the process of physicians getting credentialed is time-consuming and needs much paperwork. In order to shun the effect of credentialing, confusion with payers, and paperwork process physician credentialing services are helpful. Without wasting much time lets jump on to the different Physician Credentialing Services in 2020.

CAQH Registration

The majority of the payers in the United States have approved the identical credentialing program of The Coalition for Affordable Quality Healthcare (CAQH). It has been observed that physicians who maintain their CAQH profile up to date have lesser delays in re-credentialing as well as credentialing.

The main objective of CAQH is to increase the reach of health care and lowering the administrative challenges for physicians, healthcare providers, and staff members. CAQH registration saves time and nullifies the frustration linked with payer credentialing, which ultimately saves time. Apart from this, the electronic storage of data eliminates the requirement of paper submission.

Data Gathering

Data is the key to any industry and healthcare is no option. Outsourcing of physician credentialing services will be helpful for a physician in order to focus on the patient. The outsourced organization not only helpful for physicians to do patients required background checks but also collecting qualitative data.

Submission of Application and Communication with payer

Payer communication is an essential part of a physician when it comes to reimbursement for provided services. Submission of application and communication with payers is a service, which includes providing necessary documents, managing, and follow up tasks with the insurance companies.

Verification of NPI

National Provider Identifier (NPI) is a ten-digit identification number given to health care providers in the United States by CMS (Centers for Medicare and Medicaid Services). The verification of NPI is done by physician credentialing service provider organizations so that practitioners could concentrate more on their patients.

Moreover, there are other physician credentialing services as follows:

  • Checking, coordination with the payer for Certificate of Insurance (COI)
  • Verification of DEA
  • Background verification
  • Managing reimbursement issues
  • Verification of the American Board of Medical Specialties (ABMS)
  • Verification of state and federal licenses

Apart from physician credentialing there are other types of credentialing such as wound care credentialing, podiatry credentialing, physical therapy credentialing, chiropractor credentialing, OB/Gyn credentialing, family practice credentialing, pediatric practice credentialing, urgent care credentialing, and others.