The process of medical credentialing is a critical aspect of every practice, and that is why it requires in-depth research and meticulous accuracy. As it involves the study and absolute accuracy, the process becomes slow and not speedy! Credentialing often takes around 90 to 120 days, and it must be done because the verification of credentials is mandatory to provide medical services. Because it is a rigorous process that requires time and effort, most practices outsource medical credentialing services from companies like UControl Billing.
Medical companies usually do the primary Because it is a rigorous process. To verify that the following credentials of the providers are legitimate:
- Education
- Professional license
- Certifications
- Medical training
- Work history
- References
Good medical billing companies also provide the best medical transcription services that further help out the practice! In addition, the accountability and the reputation of medical practices are highly dependent on how compliant the credentialing process is with the regulatory bodies of the government. If the credentialing has some sort of errors, then the process would get delayed and lengthened, which will harm the billing and reimbursement of medical practice.
Now, before we move on to why credentialing requires so much time, let us first tell you in detail what medical credentialing is?
What is medical credentialing?
Medical credentialing is the process necessary for every medical practice to start doing business in the healthcare industry. Medical credentialing services offer verification that a doctor or a practice is qualified to provide medical services to patients. It is just like a driving license. The only difference is that the driving license allows one to drive, and the process of credentialing allows one to treat or provide medical assistance to patients. The services of medical credentialing are required by almost every healthcare insurance company. In order to complete the process of credentialing, one must provide all the relevant documents that also include medical license, insurance, and DEA.
Why does the process of medical credentialing take so long?
When medical practitioners get hired, they can not immediately start working at the healthcare facility. They have to wait for a few weeks to six months because of the process of credentialing. When it comes to the providers, the process only requires around 3-4 hours because they have to submit about 20 different credentialing forms. Whereas the facility staff requires almost 20-24 hours for the credentialing per provider. This is because they have to complete the following undertakings:
- Run a background check
- Collect credentials, clinical reputation and case history
- Verify credentials, clinical reputation and case history
- Collect claims, privileging and board history
- Review claims, privileging and board history
- Verify sanctions with the Office of Inspector General (OIG)
- Start primary source verification
- Present files to credentialing committees
- Current files to executive committees
- Current files to facility stakeholders
- Create a delineation of privileges
- Provide an appointment letter
The unfortunate thing is that this process is repeated whenever credentialing of a provider is done, and every facility collects the same data. Every facility has its way of collecting and verifying data, and there is no communication between the facilities. That is why redundancies occur that further delay the process. A few other factors can delay the process of medical credentialing services.
Steps involved in the process of credentialing
As we have mentioned above, credentialing has always been very slow, which makes many healthcare facilities frustrated. They have to wait for an extended period to become a credentialed or in-network provider. Here are the steps that are involved in the process of credentialing and are the reasons that make credentialing a long process:
Submission of Initial Applications
Every insurer has its application for the process of credentialing. These applications are either available on the website of insurers or can be obtained by calling or emailing them. If the application has to request, then the insurance company might take around 30 days to respond. This application can be filled in an hour or so and then has to be submitted using fax, email, or provider portal. After the submission of the credentialing application, the real waiting game begins!
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Process of Insurance Verification
It is not guaranteed that the processing of your application will start at the same time it is received, and the insurance company has to go through plenty of applications each month. Although one should call and confirm about the receiving of their application, expecting quick progress, on the other hand, is not recommended!
The insurance company starts the process of your credentialing application by performing the primary source verification. This sort of verification includes the validity of the following:
- License
- Education/diploma
- Information on the resume
The providers are told to maintain their CAQH Proview because, for verification, the CAQH Proview is used with the medical credentialing application.
Also, an insurance company employee will get in contact with the license board, college registrars’ offices, and past employers for the verification of the information that you have provided. This takes a lot of time and effort, precisely when this information is not confirmed first! Without delays caused by inaccurate or incomplete applications, an insurance company will take 60-90 days. If there is inaccuracy as incompleteness, then this might take a bit longer than that.
Meetings of Credentialing Committee
As soon as the credentialing application of an individual is processed, it is sent for the final approval of the credentialing committee. Every insurance company has different ways. And that is why some credentialing committees may sit every month or go for quarterly meetings. This is another reason that the credentialing process takes a lot of time, and your application has to sit for several weeks before the committee decides to meet.
Begin As In-Network
After the hectic process of getting your credentialing application after 30 days, verification by the insurance company in 60 days, and finally getting the approval of credentialing committee within 30 days, you can now start to treat a patient and begin your services as a medical service provider.
As the process of credentialing is very long, it is also very complex. Luckily some ways can make this process a little easy! To get your medical credentialing process in line, hire a dedicated credentialing staff or outsource from medical credentialing service providers that can take up all the burden and free you from all the worries and stress!
Let us wrap it up!
The process of medical credentialing is an on going process. And it begins with hiring the new staff and continues throughout the services of the employees with an organization. It is vital to monitor the service provider’s information continuously because any changes to exclusion or license status may occur that should be watched out for! Healthcare facilities need to know that each of their staff members is highly qualified and compliant to provide medical services. If an organization avoids the process of medical credentialing, it may have to face fines, penalties, delayed reimbursement, and loss of participation and reputation.
To streamline the process of medical credentialing and medical transcription services, in-house credentialing can be a very costly deal. This is why outsourcing from a medical billing company is preferred and suggested more. In order to get the best medical credentialing services of UControl Billing staff, visit their website now!
