3 Types of Credentialing Services

Credentialing services are a method of verifying the qualifications and background of healthcare providers. Credentialing aims to show patients and partners that healthcare providers have the necessary training, skills, and licenses to provide high-quality care. The process also evaluates whether healthcare providers adhere to professional standards and ethical codes of conduct. Here are three types of credentialing services in the healthcare industry and how they can be beneficial:

1. Physician Credentialing

Physician credentialing verifies the qualifications and background of a healthcare provider applying for a new job or contract. Physicians who are joining a new hospital or clinic typically undergo this process. Physician credentialing can be conducted by the facility’s recruitment or administration teams. A professional credentialing organization can also complete this process.

2. Credentialing Maintenance

Re-credentialing or credential maintenance is the regular process of verifying that the qualifications of an employed healthcare provider are current and relevant. This service also checks for current providers’ criminal histories and past lawsuits to make sure patients remain in safe hands. Credentialing service companies can assist healthcare facilities with credential maintenance.

3. Provider Enrollment

Enrolling a healthcare provider in a health insurance plan or network is a credentialing service called provider enrollment. This service is necessary for individual providers and larger institutions. Along with verifying the healthcare provider’s qualifications and background, credentialing companies confirm that the provider meets the health plan or network’s requirements. Successful enrollment allows the provider to receive payments and reimbursements from health insurance companies.

Benefits of Medical Credentialing Services

Medical credentialing services offer several benefits to healthcare providers and patients. Some of the most significant benefits of medical credentialing services include protection for facilities and patients, regulation compliance, and positive impacts on providers’ reputations.

Improved Patient Safety

By verifying healthcare providers’ qualifications and experience, credentialing helps patients receive high-quality care from qualified physicians. The focus on finding well-qualified providers helps healthcare facilities reduce the risk of medical errors, misdiagnoses, and other adverse medical events that could lead to injuries or lawsuits.

Compliance With Regulatory Requirements

Professional organizations and regulatory bodies set requirements for who can provide what kind of medical care. Credentialing service companies can help providers keep track of these requirements and comply with them. This can help protect healthcare providers from potential legal and financial penalties for noncompliance.

Improved Provider Reputation

Healthcare providers can improve their reputation among patients, colleagues, and employers by demonstrating that they meet or exceed credentialing standards. Credentialing can showcase individual providers’ work ethic and growth as medical professionals. A positive reputation can help attract new patients, improve job security, and generate advancement opportunities.

Outsource Credentialing Services for Your Practice

Physician Practice Specialists can reduce the time and energy your healthcare practice spends on credentialing. We can help credential potential job candidates and enroll your practice in medical insurance networks. We have 15 years of experience credentialing, consulting, and contract negotiating for medical practices across the United States. Contact us today for a free consultation or to learn more about the process of outsourcing your credentialing.