Physician Credentialing & Provider Enrollment
Health care credentialing is a verification process for academic, training and skills possessed by a health practitioner. It involves varies procedures. Some of these tasks include verification of the covered medical college, confirmation that studies were completed and verify on further training such as internship, residency and fellowship. It involves going back to the primary source of these credentials. The state license board is contacted to confirm the issuance of the license. The licenses has to be checked whether it is active o there are restrictions applicable to it. The medical school would have to be contacted to verify that a medical degree was received by the concerned party. Depending on the complexity of the process and items that have to be verified, the process can be long.
The purpose of physician credentialing is to help health care entities to allow practitioners provide services in its campuses and for providers to participate in insurance networks.
A 10-Point Plan for Doctors (Without Being Overwhelmed)
On the other hand, the provider enrollment is processed by which a service provider requests to participate in a health insurance plan. The procedure starts by application to participate in a network/plan, submitting documents for credentialing process, other documents submission, submitting a license to a carrier and signing a contract. A specific carriers may ask for other documents and procedures. Several carriers trust CAQH as a central information. For enrollment process, every physician should have an up to date profile in the CAQH system. The health insurance firms take utilize the credentialing process to check for academic verification, licensing, training and other items that are required for a particular plan After the credentialing process has been through, the network offers a participating contract.
Enrollments – Getting Started & Next Steps
The payor influences the processing time for enrollment. While some plans can be completed within 90 days; others will take up to 180 days. After submitting documents for enrollment, the provider should do a follow-up. This can be done using certified mail, emails, fax, documenting phone conversations with agents and others.
To ease the process, some companies help healthcare service providers with the physician enrollment. The provider will only part with some cash as service fee for enrollment processing and follow up. They do the paperwork and follow up on the insurance carriers on behalf on their client. Saving on time for the physician is one of the big befits of working with these firms. The physician also stands to befit from their daily experience working with the insurance firms. Physician credentialing and provider enrollment should not be a nightmare for a service provider after updating their profile with CAQH system and working with facilitating companies. A clean track record of the physician is required for the process to go as smoothly as possible.