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What You Need to Understand About Physician Credentialing

The physician offices, hospitals as well as managed care insurance companies and the different laboratories all credential the physicians. You have to know that credentialing is actually the act of gathering information about the doctor or medical provider to verify their qualifications when it comes to practicing medicine in their specialty.

There are many agencies which oversee the credentialing processes. Know that there is a leading agency which monitors the credential as well as the qualification standards in healthcare. Medical providers must go through the process of credentialing before they are hired by the medical facilities or the insurance companies. You must know that physician credentialing or the medical credentialing would verify licensure, training, education, quality, general ethical standing of a provider in the medical community.

The process of credentialing is going to start by submitting the required information to the credentialing agency for evaluation. The areas of focus actually include board certification, education, licenses, malpractice claims, background check, resume with a detailed work history, personal references, privileges, malpractice insurance and others.

The information gathered are going to be reviewed by a physician peer-review committee. The committees would actually make recommendations to the professional as well as the standing of the provider in the community. Committees are going to evaluate the ethical behavior of the medical provider.

The insurance companies including the government-sponsored payers, will look for the physician’s medical credentials before accepting the professional into a group of participating providers. The Medicaid and the Medicare will not permit the physicians not undergo the credential procedures to bill for services. Managed care organizations do have such strict physician credentialing process before the provider is listed as participated with the insurance company. A lot of private physician credential the doctors to guarantee quality care delivery.

It is through credentialing that the customers can assure that the medical providers were reviewed by the peers. Such would provide much higher level of trust and make sure that the provider is licensed as well as certified and hasn’t had the licenses or privileges revoked by another state. However, it can’t determine the quality of the delivery of care by the provider. So many credential committees implemented policies that the providers must participate in like periodic credential updates and reviews to keep the status current.

So many companies actually specialize in the provider credentials like the medical practice consultants. Such companies would consult with the medical facilities and the provider practices in order to monitor and also ensure that the physicians’ credentials are kept updated and current.

Attributed by: my company