How can medical practices uphold a steady credentialing process?

Managing a hospital or a large practice requires you, as a healthcare professional consultant, to fulfill some tasks. Provider enrollment & credentialing is one of the most critical tasks. It looks easy on paper but difficult to execute in reality. It is the process by which a provider becomes associated with the insurance program and an authentic member of a practice or a hospital.

Medical credentialing includes a check of your education history, degrees, certifications, work experiences, prior places of work, and licenses. After all the information is checked, you are enrolled in
Medicare, for instance, to be reimbursed in the future. Once you are through with the accreditation, it gives your professional education with greater authenticity.

There are specific factors you must keep in mind moving forward with enrollment & credentialing.

1. Allocating enough workforce

Credentialing is a physically demanding job. If you are not allocating enough resources to it, it will cost you in the long run. You need people to collect the evidence from universities, workplaces, and even government agencies; information that solidifies a medical professional’s status as an authentic provider. There is a list of things that you will be collecting and including in the application for provider enrollment & credentialing. As a hospital, if you lack a dedicated department for credentialing, it is best to put this responsibility on the industry experts who can spare the time and resources required for it.

2. Staying on top of payers

Even if you are filling the forms with correct information, there can be delays. The insurance companies already have loads of applications pending approval. The way you cope with this delay is the real test. After a few days of mailing provider’s data, check with the insurance companies if they have received the details. Keeping at it, following up with them is the key. Attach any digital receipts and courier copies to the email as a precautionary measure. There should be eagerness when it comes to healthcare provision and activation.

3. Establishing a credentialing system

For an extensive practice or hospitals, a credentialing system should be in place. Any new providers looking to get enrolled can pass through the system to save themselves from stressful situations. When the steps of the process are predefined, the system becomes uncomplicated. Streamlining the system includes asking the providers to maintain the most recent profile in the CAQH (Council for Affordable Quality Healthcare) database. CAQH helps maintain the providers’ data at a single location and payers can access it any time. If the provider’s file is up-to-date, it also helps in the re-credentialing process.

4. Building an approachable relationship with the payers

It is always a good idea to build a meaningful relationship with the payers. For any problem in the provider’s application, you should be able to talk to the payers directly. It is not a good idea if you have to wait longer or if there is no answer at all from the payers. Ensuring an excellent working relationship with the insurance representative will overcome any potential issues that may arise in ensuring reimbursement of claims.