Credentialing Tips for The Average Joe

What Is Meant By Physician Credentialing? Be it physician offices, managed care insurance companies, laboratories and hospitals, all are credential physicians. As a matter of fact, credentialing is the act of getting information about the medical provider or doctor to be able to assess their qualification to practice their specialty profession. There are numerous agencies that oversee physician credentialing process. URAC or Utilization Review Accreditation Commission is among the best agencies that are keeping track of the qualifications standards and credentials in health care. Medical providers must be able to pass the process of credentialing before they could be hired by insurance companies and medical facilities. Whether you believe it or not, physician credentialing is called sometimes as medical credentialing and verifies licensure, training, education, quality as well as overall ethical standing of the healthcare provider in medical community. As for the credential process of doctors, this begins with medical provider submitting info to the credentialing agency for review. Some of these areas of focus consist of education to verify the medical school as well as any post graduate training, board certification, to know specialty training and certification, licenses in which the doctor holds licenses, background check that is done to see if the person has any criminal history, malpractice claims that is used to check for malpractice claims or awards, malpractice insurance, which ensures that there’s appropriate level of insurance, resume detailing work history as well as personal references.
Doing Enrollments The Right Way
The physician peer review committee will gather the information and review it. These committees will make recommendations to the standing and professionalism of the provider in the medical community. Normally, the committees evaluate the medical provider’s ethical behavior.
Doing Enrollments The Right Way
Basically, the insurance companies including government as well will research for the medical credentials of the physician before they decide to accept him or her into the group of participating providers. More often than not, they won’t be accepting any physicians who haven’t gone through physician credentialing to bill for services. A strict physician credentialing procedure is implemented by managed care organizations before a provider can be considered as part of the insurance company. In reality, many physicians practice credentialing their doctors to guarantee the quality of care delivered to patients. Provider credentialing is so important because this assures patients that the medical providers have been assessed by their peers. This is providing high level of trust and set assurance that the provider is board certified and licensed and not had privileges revoked in other states. But this can’t be used in determining the quality of care provided but it is actually something that should not bother you as credential committees implement policies that mandate providers to partake periodic credential reviews and updates to keep their status active.