5 Useful Tips from Experts in Provider Credentialing

March 16, 2020

Provider Credentialing has become excessively popular in the medical world. It is the process by which the insurance networks, hospitals, and other healthcare organizations verify the details of the doctor and get them registered with the insurance providers so that they can get the reimbursement from the insurance providers promptly. No doctor can continue to work if they don’t get paid for their services and to get paid, credentialing is a must for all medical practitioners. The absence of credentialing can lead to loss of revenue for the medical service provider which is highly undesirable.

 Here are five useful tips from experts in provider credentialing which can make the entire work easy and smooth for you : 

1. Start early

The first and foremost requirement is to start early. Credentialing can be done within 90 days and if we think, it seems to be quite a long duration however 90 days are not enough. It is best to start the credentialing process almost 150 days before the practice so that all the formalities can be completed well in time and any technical or document glitches can be taken care of. The insurance companies have their ways of working and they might delay the process on their end so it is always better to start early.

2. Stay organized

While filing your application it is important to stay organized. For that, you should make a checklist of the documents that are required and arrange them well in advance. It is necessary to check properly that all the documents have been submitted in the required format so that there are no problems. The application should be complete with no missing, outdated or incomplete information. Make sure that you provide all the up-to-date information. Also, you should keep a record of the submission dates of every application and make sure to send constant reminders and enquire about the application process to make sure that you don’t miss out on any of them. 

3. Stay updated with CAQH

The Coalition of Affordable Quality Healthcare (CAQH) is widely accepted by a lot of payers so the medical providers need to update and attest their information with the CAQH to ensure smooth credentialing and re-credentialing process. With CAQH the practitioners can make an online credentialing profile that can be easily accessed by the online companies to record the information of the doctors on their insurance panel. 

4. Be aware of the state Regulations

Every state has its laws for the credentialing process and there may be reciprocity agreements based on the payer and other credentialing organizations of the state. Understanding the state regulations help in easy and efficient credentialing without any delays and errors. It ensures that you receive the payments timely and efficiently. 

5. Maintain a sustainable credentialing process

Creating the workflow for credentialing is difficult but it should be done properly as it helps in the long run. All the necessary documents and forms of the medical practitioners must be maintained in the workflow even if the credentialing process is outsourced. Credentialing is not a one-time process and the need for re-credentialing arises after every 3 to 5 years so it is best to keep all the information stored in the workflow and keep updating it to ensure quick re-credentialing. 

In the current scenario, it is best to outsource the credentialing service to trusted providers like HRX. This leading firm has experts who work for the medical service providers round the clock and provide the best credentialing services. Through their experience and efficiency, they make sure that all the documents are submitted in the correct format and on time. The firm also follows up with the insurance providers on a timely basis to avoid any delays. 

Outsourcing the service is beneficial as the hospitals need not keep a separate staff member to perform all these tasks which can be done by a team of experts in a highly affordable and secure manner from outside. Moreover, being the experts, the credentialing companies are very well aware of all the rules and regulations along with the relevant laws of different states which makes the process easier and more efficient. With HRX you can be well assured that your credentialing process will be completed well in time without any hassles or errors.

By: hrx portal Category: blog