Medical Credentialing Services – Understand How It Works?

Medical Credentialing Services – Understand How It Works

Medical credentialing is one inevitable process in an individual general practitioner’s life, but not many people understand its importance. Learn this guide to know about medical credentialing services and understand how they really work

The life of a doctor may seem appealing and promising, but it’s indeed the toughest job in the world.

As a practitioner or health service provider, you are going to be responsible for many patient’s lives so your credibility and status mean a lot. 

Before starting practicing individually, a physician or any health care provider needs to go through a critical process of Medical credentialing, to mark his/herself legal and competent enough to perform without guidance or supervision.

But do you know what medical credentialing really is? And how it works?

With this guide, you will get the answers to all your questions. So, let’s begin

What is Medical Credentialing?

Medical credentialing is a diligent process of obtaining, verifying, and assessing the qualifications of a health care provider to ensure that they are competent enough to provide medical care to patients. 

The credentials are actually documented pieces of evidence of license, training, experience, and other qualification; which are assessed during the process by medical credentialing services

You need this process to get the status of a LIP – a licensed individual practitioner who is permitted by law and regulations, to provide care and services without any supervision within the scope of their license and consistent with the privileges proffered by the organization. 

In simple words, it’s a license given to you by law and government to work individually and without any supervision. 

Why Is Medical Credentialing Important and Beneficial?

What are the risks of letting a truck driver to fly a plane? Or a nurse to perform heart surgery? Yes, exactly.

Most of the time, patients don’t know well or at all about their doctor’s qualifications and experience.

All they see are a couple of degrees hanging from the wall with some alphabet soup which is unable to understand by many people. 

Medical credentialing is highly important as this process allows patients to put their trust in the chosen health care services and providers.

This is a procedure through which law, government, and the organization (that you are applying for) make sure that the patients are getting nothing but the best. 

There are also many advantages of the medical credentialing process.

This procedure provides quality assurance to the medical industry that benefits all the involved parties.

It maintains confidence in the quality of medical professionals, minimizes the risk of medical errors, protects your organization from a potential lawsuit, and keeps the costs down.

Who Needs to Receive Their Medical Credentials?

To work individually or with an organization, medical credentials are required by a variety of health service providers including nurses, physicians, podiatrists, ophthalmologists, specialized surgeons, etc. 

Not only individuals or practitioners, but many medical facilities, need medical credentialing to maintain the standards of care and competency.

The facilities and services that are obliged to obtain the proper credentials to perform as health care providers include:

  • Ambulance
  • Home health services
  • IV home infusion therapy
  • Radiology/Diagnostic imaging
  • Hospice care
  • Durable Medical Equipment
  • Dialysis 

There are many other facilities that need proper medical credentialing services to provide their services to the patient. 

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How do Medical Credentialing Services work?

The procedure of medical credentialing is carried by verifying and assessing all the documents of the provider to ensure that they are valid and current.

All these documents include their medical license, malpractice insurance, and other additional information including practitioner’s CV, board certifications Internship and Medical school information, etc. 

The process involves direct contact with the primary sources for the verification of the health care provider’s credentials.

The CVO or credentials verification organization will communicate with the institutes from where the practitioner received their degree, had their training, and did their residency to confirm the information.

The CVO staff will begin the process to assess and verify the credentials from the source.

After verifying, they will prepare a file and send it to the credentialing committee to review.

After the process, the credentialing committee will make the final decision that whether this application will be accepted or denied. 

Usually, a letter along with the committee’s decision is sent to the applicant to inform them regarding the status of their application. 

Making it simple to understand, this whole procedure consists of two parts; credentialing and privileging.

Credentialing where verification takes place in the light of education, training, license, and work experience.

Where privileging is granting official approval to the practitioner to perform various practices based on the demonstration of competency. 

Why should You Choose Medical Credential Services?

Usually, practitioners and physicians need to get into the tedious paper-based credentialing process before a health plan can contract with the provider or an organization can grant affiliation. 

However, the automated and electronic process has greatly reduced the burden.

Nowadays, you can reach for an online credentialing process from a reliable medical credentialing services provider to lessen the burden, elevate the process and provide accurate results.

Many organizations still use slow, and manual paper-based credentialing processes that take ages to complete and never truly guarantee transparency of provider’s credentials. 

The risk of errors is also high in the paper-based credentialing procedure. 

A simple human error during the handling of the clutter of paper documentation necessary for credentials can authorize physicians to perform tasks that don’t come under their scope of expertise. 

This little mistake can cost a patient its life. This is why an electronic credentialing process is highly suggested for practitioners and services as well. 

Also, the medical credential service providers assure quick and high-standard provider’s data, license verification, continuous monitoring, and updating of the data through the cloud-based credentialing platform.  

Final Notes:

Medical credentialing is a process that is not only necessary but also very beneficial for everyone associated with the medical industry.

Medical credentialing services not only make this process easy for you, but also ensure the transparency and integrity of the provider’s data.

Just make sure to approach a reliable medical credential service provider to get your work done in a satisfactory way.

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