What Is Medical Credentialing and Who Needs It

Medical credentialing is a process that healthcare providers and organizations undertake to verify healthcare professionals’ qualifications, training, and experience. The process ensures that healthcare providers have the necessary skills and expertise to provide quality patient care. Credentialing companies can help collect and verify information that proves a healthcare professional’s legitimacy. 

Who Needs Medical Credentialing?

Medical credentialing is required for all healthcare professionals that provide services. At Physician Practice Specialists, we help physicians, nurse practitioners, physician assistants, therapists, labs, ASCs, and behavioral health providers through the process. Credentialing is mandatory for healthcare providers who want to work with insurance companies, hospitals, and healthcare organizations. Private insurance companies are not the only insurances that require credentialing. Healthcare providers wishing to participate in Medicare, Medicaid, and other government-funded healthcare programs must also undergo credentialing.

Why Is Medical Credentialing Necessary?

Credentialing companies like Physician Practice Specialists can make credentialing easier and help protect your organization and its providers. Medical credentialing is necessary for other reasons, including:

Patient Safety 

Allowing underqualified medical professionals to practice at your organization can be unsafe for patients. Credentialing may help lower the number of medical errors committed within your facility, which helps keep patients safe from medical professionals who are not fit to practice. By staying informed with the latest medical practices through renewing credentials, patients can receive the care they need with the most up-to-date techniques. 

The law requires medical providers to undergo the credentialing process, and failing to do so could be a liability for your facility. If a malpractice claim is made against a provider who has not been verified, your facility could be at fault and face expensive fees. Making sure that all providers go through the credential process can also help protect your facility from getting fined or shut down for not complying.

Insurance Reimbursement

Medical providers and healthcare facilities generally have contracts and agreements with insurance companies. After providing patient care, the insurance company will pay the provider or the facility based on the agreement. Insurance companies require medical credentialing before paying providers, so not going through the credentialing process could lead to financial losses. 

Maintain Credibility

Medical credentialing helps maintain a healthcare provider’s credibility and professional reputation. It demonstrates their commitment to providing quality patient care and their dedication to their profession. The facilities employing the providers can also maintain their credibility and reputation through this process.

Credentialing Companies Are There for You

Medical credentialing can be a long and challenging process. Becoming fully credentialed typically takes 90-120 days, but that is if no mistakes cause your application to be rejected. Credentialing companies such as Physician Practice Specialists can take care of the process so that you do not have to. We have provided contracting and insurance credentialing services for over fifteen years and have maintained an A+ rating from the BBB for the last five years. Our professionals have years of experience to make the credentialing process as smooth as possible. Contact us today for credentialing services and provider enrollment.