Step-By-Step Credentialing Manual

Credentialing process is a necessary evil every physician has to go through. Postponed or done haphazardly until a month before a physician starts working, it can turn into scheduling nightmares, cash-flow delays, and other unpleasant things. Fortunately, there are several steps to minimize the possible issues with credentialing. The following steps are quite simple, yet proven.

Start well in advance

Though an average credentialing process can be finished within 90 days, give yourself at least 6 months. As payers have supersized, an ability to expedite an application has disappeared. Physicians have to work on a timeline of someone else, usually payers, and each payer has different timelines for processing an application. So, be patient and wait.

Pay a lot of attention

Credentialing managers say that the most common mistake in applications is that they miss information that's crucial for processing. Outdated, incomplete, or missing data usually appears in the following fields:
• malpractice insurance
• attestations
• hospital privileges
• current work status and work history
If you provide a comprehensive list of your training, education, experience, etc., you will probably avoid the vast majority of delays. Getting everything right the first time means you'll get a new physician credentialed within 90 days.

Get yourself acquainted with CAQH

CAQH, or the Coalition for Affordable Quality Healthcare, created a uniform credentialing program 15 years ago. Since then, many payer across the country gave adopted the program. Physicians who update and attest with it find credentialing and re-credentialing processes much easier and faster. CAQH doesn't allow you to follow temptation and leave data entry boxes empty or send an incomplete application. It's important, because applications with missing information are simply rejected. Because credentialing decisions take months, you'll lose a lot of time and have to do a lot quickly. So, with CAQH you'll attach all required documents and provide all information. And never try to simply remember important dates and events - always have your documents with you.

Link a start date of a physician

This can be a bit controversial, since many hospitals are afraid of offending a new physician by asking to submit the requisite credentialing paperwork. However, it's quite comfortable to link a start date to the submission of the paperwork. For example, the date might be at least 3 months away. It's better for both hospitals and physicians, who at least will know a preliminary schedule of the credentialing process.

Know all regulations and laws

Different states have different laws for credentialing, including in-state credentialing (a physician change one practice to another within one state doesn't have to go through all credentialing process again), and reciprocity regulations (if a physician was credentialed in another state, sometimes he/she will have to repeat the process). Usually contacting local medical society or association is enough to get all necessary information, avoid mistakes and use laws to your advantage.

Credentialing can be tedious, especially if you don't provide enough information from the very beginning. Hospitals make strong efforts to gather all data from new physicians, and when done properly, credentialing is a much less painful than it might be otherwise.

Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.

©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  All Rights Reserved.

Simple Guide For Establishing Credentialing Process

Simple Guide For Establishing Credentialing Process

As a board member, you probably understand the commitment your healthcare facility has to the local community to ensure highest quality care is delivered at your hospital. But do you know the impact of this commitment at every meeting when you grant privileges or give credentials? Physician credentialing is the crucial task you have to undertake to ensure your patients receive safe and quality health care.

Simply put, the main aim of credentialing is to ensure only professional doctors are allowed to be among the medical staff, and that they deliver procedures within their competence and experience. The credentialing process involves establishing realistic requirements and evaluating physician's qualifications for obtaining a certain status. The first step of credentialing includes considering and agreeing on professional experience, training, and other requirements that physicians have to meet in order to get credentials. The second step includes obtaining and verifying information about the skills and qualifications of every physician. In other words, credentialing process is needed to prove that each physician:
• provides honest and complete information
• has all licenses
• has malpractice insurance
• meets the standards established in a particular hospital

In the past, credentialing required applicants to present only several papers, such as their certificate or diploma. Nowadays, however, it's much more complicated and requires verification of primary sources - schools, licensing agencies, residency programs, etc. - to guarantee that physicians' training, education, licensure and other papers are legitimate. Primary source verification is important in both meeting standards of accreditors and avoiding possible legal problems.

One of the key aspects of the credentialing process is granting privileges to an applicant. Granting privileges is a three-step process, which are:
• determination of treatment and diagnostic procedures that a hospital is staffed and equipped to perform
• setting the minimum experience and training needed for a physician to carry out the procedures
• evaluation of whether or not a physician meets the requirements and allowance of performing requested procedures and treatments

Delineation of privileges refers to a process that determines what treatments and procedures can be performed at the hospital. As new technologies are implemented, privileging physicians become more difficult and challenging for hospitals. Delineation of privileges should be flexible, so that hospitals can add new conditions to treat and new procedures, but it also should be consistent, fair, and firm.

To start the credentialing process, the board should specify criteria that will be used to make decisions at each step. The board should also make sure that the process is fair, consistent, functions properly, and thorough.

Then the board should decide which physicians will be allowed to enter the medical staff or remain there, and which conditions they may treat. In the past, boards' role in the credentialing process was insignificant, but today they are directly involved in the process.
Verifying information provided by a physician protects patients and reveals any details that could stay hidden otherwise.

Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation
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©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  All Rights Reserved.

Physician Credentialing Requirements

Physician Credentialing Requirements

The governing body of each healthcare facility is responsible for credentialing process and can delegate some responsibilities to the staff of the hospital for proper implementation. Qualifications to provide treatment and care to patients that are verified include: checking with NPDB, or the National Practitioner Data Bank, confirming current professional licenses, confirming board specialty certifications, checking with HIPDB, or the Healthcare Integrity Protection Data Bank, CSA (Active Controlled Substances Act) database and other databases, confirmation of membership in associations, and confirmation of degrees.

Hospitals may implement different credentialing criteria, but there are still some requirements established in the vast majority of hospitals. It includes competence, character, judgment and experience.

In many states, hospitals also require an active collaborative practice agreement that should be on record before credentialing. This agreement refers to a relationship between a collaborative physician and the NP. It allows NPs to independently care for his patients within given guidelines and according to regulations. When you successfully complete all the paperwork, the hospital will verify that they believe in your qualifications and provide you patient care at the facility. However, re-credentialing is needed every 2 years, so it's vital to maintain all documents and papers.

Privileging refers to a process by which the same hospital that approves your credential application grants permission to provide some aspects of patient care. For example, privileging may include prescribing, admitting and performing some procedures. Sometimes, a physician may be trained, credentialed and licensed to provide patient care by the Nurse Practice Act, but usually your practice is limited by the privileges you got within the facility.

In additional to health care institution credentialing, a physician should also be credentialed by nonprofit and for-profit insurance companies and Medicare and Medicaid programs, which are sponsored by the government. Health insurance organization credentialing will allow you to bill for care provided. The paperwork may vary quite dramatically, but most of the time, you should obtain a National Provider Identifier number, which will recognize you as a unique health provider and also as the one who can maintain licensure and certifications. You can apply for the National Provider Number at the US Department of Health and Human Services. Once you have it, your power and validity as a health provider will increase.

As an applicant, you also have your rights. In particular, you have the rights to be informed of the following:

• Right to correct mistakes, conflicted information and erroneous
• Right to review the information you submitted for credentialing
• Right to get informed of the status of your application, upon request

You should direct all questions and request to the consultant at the hospital you're going to practice in. However, you won't be notified if your application has errors or mistakes and can be simply denied without telling you the reason. Therefore, check your application multiple times to ensure it is error-free and provide comprehensive information about you and your working experience. You're the only one who can correct conflicting information and errors.

Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.

©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  All Rights Reserved.