Are you a healthcare practice owner in search of the best way to hire and retain medical providers who are qualified and compliant with payer policies? If so, credentialing should be at the top of your list. Credentialing your practice can be tedious, but it is essential to running any healthcare business. It ensures that you meet the necessary requirements to provide quality care and remain fully compliant with state and federal regulations. By credentialing your medical staff and yourself correctly, you are also providing increased protection for both your patients’ safety and practice.

Developing an effective credentialing strategy can greatly benefit your practice by reducing time-consuming paperwork while strengthening visibility to become more attractive to prospective patients. Keep reading to discover everything you need to know about the credentialing process so you can provide safe, quality care for all of your patients.

What is Credentialing?

Credentialing is the process of verifying and validating an individual’s qualifications, credentials, and experience. This process can include background checks, licensure verifications, reviewing references, educational history reviews, or any other form of qualification confirmation. In some cases, the credentialing process also includes reviewing professional performance records.

How to Get Credentialed

The credentialing process can be a lengthy one and requires patience. It involves:

• Review Requirements: The first step in the credentialing process is to review any requirements and guidelines set out by your payer or state licensure. Different states may have different regulations, and you should familiarize yourself with them before moving forward.

• Gather Documentation: You will need to provide documentation such as resumes, transcripts, diplomas, certifications, medical licenses (if applicable), board certifications, DEA numbers (if applicable), and malpractice insurance information for all individuals who are seeking credentials. Ensure that all of these documents are up-to-date and verified before submitting them.

• Submit Applications: Once you have gathered all the necessary paperwork for each individual, submit applications for each provider to their respective payers. Each payer will review the credentials and, if approved, add the provider to their list of authorized providers.

• Enroll in Payer Networks: Once the credentialing process is complete, you can enroll in preferred provider networks or other networks with specific payers. This allows you to offer your services to their members who are likely looking for providers within these networks.

The Benefits of Credentialing 

Credentialing is an important part of your practice’s success. It not only provides you with the assurance that you are meeting all of the requirements to provide quality care and remain compliant, but it also helps with the following:

• Increased Visibility: Credentialing your practice allows you to become more visible to potential patients and payers. This makes it easier for them to find and choose your services, increasing the chances of gaining new patients.

• Improved Quality of Care: Providers who have been credentialed will be up-to-date on their skills and knowledge. This ensures that they provide the best quality care available, keeping you and your patients safe and healthy.

• Higher Reimbursement Rates: When enrolled in a preferred provider network, you can experience higher reimbursement rates from payers and increased patient satisfaction due to the quality of care being provided.

• Enhanced Compliance: Credentialing your providers and yourself ensures that you comply with state and federal regulations, providing better protection from potential lawsuits or penalties.

• Timely Processing: Proper credentialing ensures that the paperwork process is streamlined, helping to reduce the amount of time it takes to get approved by payers. This helps keep administrative costs down while still providing quality care for your patients.

Let MyeMed Help You!

Credentialing is a multi-faceted process that is essential for healthcare professionals. With most hospitals and practices requiring current credentials to be updated regularly, it’s prudent for all practitioners to be aware of the importance of credentialing at all times! Credentialing is beneficial not only because it helps maintain quality care from healthcare professionals but also keeps patient records up-to-date and secure.

If you are confused about the process or need assistance with updating your credentials, MyeMed Management LLC can help. We offer comprehensive services to ensure your credentials stay current without adding too much extra effort. Please fill out the form below to contact us and learn more!