credentialing is the process of verifying
information about medical staff and physicians to
ensure legitimacy and experience. States and
insurance providers conduct medical credentialing
to determine which hospitals and private practices meet their
requirements. Hospitals and practices will also use their own
employees or hire outside firms to conduct the
verification process with medical staff
is a very thorough, time-consuming procedure. The
length of the process depends on the applicant and
the laws of the state where the hospital or practice resides.
Physicians take a much longer time to investigate
because licensures, completion of residency
programs, authentication of services, and other
qualifications must be confirmed.
credentialing may also involve investigating any
liability claims, references, association
memberships, and status with the Department of
Health and Human Services.
Medical Credentialing is the process of becoming affiliated with insurance companies so that you (the medical provider) can accept third party reimbursement. While important for the success of a clinical practice, medical credentialing is an unwelcome distraction from providing quality care to patients–but it doesn’t need to be!
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