Category Archives: Credentialing

The Dos and Don’ts of Medical Credentialing

Medical credentialing is a necessary, but complicated, process. After all, ensuring the qualifications of a physician is easier said than done. While medical credentialing will never be easy, there are ways to make it less stressful on you and your physicians. Here are some things you should do, and some things you shouldn’t do, when it comes to medical credentialing:

DO start early

The Dos and Don'ts of Medical Credentialing

Medical credentialing takes time, and you need to make sure you have enough of it. It takes roughly three to five months in order to receive a completed contract, that’s almost half of the year. To save yourself a few headaches down the line, start the process as early as you can.

DON’T accept incomplete applications

Medical credentialing needs to be done thoroughly and accurately. This cannot be accomplished if people don’t fill out the proper information. If you notice missing information on any applications or documents, send them back and request that they be filled out in their entirety.

DO go to primary sources

In order to be sure of your facts, you need to go directly to the source. This is true for journalism, as well as credentialing. When checking the qualifications of your physicians, go straight to the physician’s medical school or residency program in order to get your information.

DON’T have just one way to contact references

As you’re requesting references, be sure to ask for multiple forms of contact information. This means asking your physician to provide not only a name and phone number, but also a reference’s email and even their address. This will ensure that you can contact each reference and hear from them directly.

DO consider outsourcing your medical credentialing

Medical credentialing can either be done in-house, or it can be outsourced. While having it in-house is convenient, oftentimes practices don’t have time to thoroughly credential each candidate. Outsourcing it, however, will ensure that it’s done in a professional and timely manner.

Here at Medical Revenue Associates, we can take on the credentialing process so that you don’t have to. Give us a call at 215-497-1001 to learn more.

Individual vs. Group Credentialing

Medical credentialing ensures that a physician both has the proper education to perform their services and is “in-network” with health insurance companies. As such, the credentialing process involves collecting and evaluating all available data on a physician in order to ensure their credentials. While you can credential individuals, you can also credential people as a…

Common Questions About Medical Credentialing

Medical credentialing and contracting is required for a provider to receive payment for their services. Medical credentialing is a complicated process that takes time and precision. There are many steps and doing just one thing incorrectly can upend the process. Here are some of the most commonly asked questions about medical credentialing: How long does…

What is Medical Credentialing?

Ensuring a healthcare provider has the proper education, training, certification and credentials not only makes certain that they are qualified to provide care, but it is also integral to being “in-network” with health insurance companies. Credentialing makes this happen. But what is it and how, exactly, does it work? Here are the details: Credentialing—The Basics…

Credentialing Services: Adding or Removing a Physician from Your Carrier Profiles

Being a practice within a managed care carrier network or multiple carrier networks means inevitably having to add or remove a physician from your carrier profile. This process involves an application process (completing the 30-page Council for Affordable Quality Healthcare (CAQH) questionnaire) for a specific network and must be completed whenever there is a provider…

Credentialing Services: Benefits of Joining a Carrier Network

Taking the time to join an established provider network can sound like a huge drain on office resources but doing so can be a major benefit for healthcare providers in the practice, as well as your patients. In-network vs. out-of-network Most patients with insurance have the option of choosing a doctor or healthcare provider that…

What to Know About Credentialing and How Long Does the Process Take?

Being a credentialed practice helps you get “in-network” with insurance companies. Patients will almost always look for providers that readily accept their insurance, as it usually more cost-effective for them and makes the payment process easier. However, becoming a credentialed practice is not necessarily a brief and easy thing to do. The process usually takes…