Why is credentialing important for healthcare professionals?

Medical credentialing verifies that nurses and doctors are properly trained and certified. Also, it verifies if they have the required professional experience to provide healthcare services to patients. Similarly, insurance credentialing is the process of becoming affiliated with an insurance company, so that the provider can see patients.

Prepare for credentialing

With so many documents, the credentialing process can often be overwhelming to healthcare providers.  In short, the process has two steps: 

1. Credentialing: The credentialing phase is when the insurance company checks all your credentials. Moreover, it verifies if you meet their requirements for participating in their network.  
   
   
2. Contracting: The contracting phase is where the company issues you a participating provider agreement. This is to say, it defines the terms of participation for receiving in-network reimbursement for your claims.

Why medical credentialing is important?

Some of the advantages of medical credentialing are as following:

Credentialing increases trust

Verifying the qualification of hospitals and healthcare agencies assures patients on healthcare professional’s merit and experience. This allows them to place their trust in their chosen providers.

Prevent losing revenues

Credentialing can help prevent medical practices from losing money in lost revenue from delayed or denied reimbursements. To clarify, neglecting to receive proper credentialing an result in insurance payers failing to reimburse medical practices for their treatments.

Lowers the risk of medical errors

It is estimated that about 98,000 Americans die from medical mistakes every year. This alarming number forces industry leaders to push for better standards of exposure and competency to disciplinary measures against healthcare professionals. Credentialing for healthcare facilities and independent practitioners lowers the risk of medical errors.

Protects you from lawsuits

Having an accurate and complete record of every practitioner’s credentials will prove to be helpful in litigation. For example, if there is a negligence claim on a healthcare professional in your institution, you can save yourself. In short, you can save your facility from a lawsuit by confirming that you verified all of their credentials as required.

Credentialing with insurance networks

The process takes patience and time. First, you have to decide to proceed with the process. Second, you have to shortlist the insurance companies you want to work with. Finally, it’s time to take the first step. It is important to know that the credentialing procedure may take a few months.

Checklist for beginning the process

• Get in touch with the network provider services department to ask about their credentialing process. Secondly, get an application from them. 
•  Fill your application. List all service locations for your practice, sign and date your application. Add copies of all required documents.
• Make sure that your profile is recent with all information. For example,  documents such as insurance, license, board certifications, etc.
• Keep a copy of your application.
• Double-check with the insurance firm that your application was received. Also, follow up with the insurance network regularly until your application is accepted. After that, you will be given a participating provider agreement.
• Review your participating provider contract for details of your requirements. This includes claims submission procedures, timely filing limits of a network provider, fee schedule for your services, and all other key contract conditions. 
•  Make sure to keep a final copy of your network contract.

Conclusion

You no longer have to waste time sorting out or hunting down forms. Certainly,MedsIT Nexus understands the insurance payers’ expectations and how to meet them effectively. Here are the reasons why you should choose a top credentialing and coding company such as MedsIT Nexus for your enrollment problems.