The physician credentialing process is an important phase and requires organized efforts to complete it successfully. According to the U.S. Bureau of Labor Statistics (BLS), demand for physicians, nursing staff and medical assistants is expected to grow by 11% in the coming years and the healthcare sector must be ready to handle provider credentialing.Â
What is the physician credentialing process? Physician credentialing is a lengthy process and involves extensive documentation and expertise. This is why most of the medical providers employ the services of credentialing vendors who can strategically handle the process and automate the workflow. To get an overview of what is physician credentialing process – let’s enlist here some of the major steps that credentialing vendors take to complete the process.
1. Collection of information and documents
As soon the medical providers enlist the medical staff for credentialing, they must provide them instructions, forms and checklists elaborating what information is required. This includes accurately filling the forms, furnishing an updated CV and providing all the required documents. List of documents includes educational documents, professional certifications, affiliations, references and past work experience. While collecting information, providers must make sure that the list is complete and physicians have provided the up-to-date information to ensure the completeness of the application.
2. Checking accuracy and data verification
Some healthcare providers take services of the credentials verification organization (CVO) to authenticate the accuracy of the information to save time. However, if the crosschecking of the information is done in-house, it consumes lots of time and requires dedicated efforts of various human resources. The check includes verifying the current status of the licensure, professional references and work history checks, verification of educational documents and checking the history of malpractice. Mostly big medical providers or hospitals have dedicated staff members to scrutinize every part of the physician application and highlight missing pieces of information. It is recommended to follow a checklist to make sure that nothing is missed out. A physician may have a malpractice history but it does not mean that the physician cannot be credentialed rather providers need to verify that the legal suits were settled and closed.
3. Submitting the application for review
Once all the documents and information is deemed accurate internally, the application is submitted to the concerned body for review. After the application submission, a dedicate resource must follow up and communicate to take the latest status. Accurate submission of the application expedites the credentialing process, otherwise, objections and resubmissions take extra time and costs.
Once the organization verifies that the application is complete and the information is accurate, they award the credentials to the provider. If everything goes as planned, the provider can be credentialed in as short as 30 days, however, the process can take 30 to 90 days to come to fruition. Every organization and insurance company have their own set of requirements, therefore the staff responsible for credentialing must make a list of all insurance companies and finalize the requirements for each of them.
The optimized and automated credentialing process is a must to expedite the physician on the boarding process and perform the duties as an in-network provider. This is why most of the medical providers outsource the process to credentialing vendors, as they can complete it in the minimum possible time with the help of advanced software tools and follow-ups, saving time and administrative costs of healthcare providers.
