Medical Credentialing 101

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Did you know that some version of verifying a medical practitioner's credentials exists back in history to the Middle Ages and even to the ancient Persians? For many millennia, kings and other rulers devised guidelines that physicians would have to meet in order to be deemed qualified to practice medicine.

Today this concept is known as medical credentialing and it's a critical component of good quality medical care at doctor offices, hospitals and other medical care facilities.

The process of medical credentialing assures patients that the doctors from whom they receive medical care have been thoroughly vetted and have had their qualifications and practice history verified through an established process. Credentialing also ensures that you, as a medical practitioner, can continue to see your patients.

How Medical Credentialing Works

Once an application is received by a carrier or facility, a typical medical credentialing process might include some or all of the following:

  • Gathering information from an application on a practitioner's qualifications and background. The background information will be checked against sources like the NPDB or National Practitioner Data Bank and the American Board of Medical Specialties.

  • Contacting the schools and hospital programs to ensure that the doctor's training has been completed and accepted by the board.

  • Contacting the state where the doctor holds an active medical license.

  • Contacting the appropriate agencies to confirm that the doctor is authorized to write prescriptions.

  • Contacting Medicare and/or Medicaid for any negative history.

  • Reviewing the doctor's history for any disciplinary actions, malpractice claims, hospital privileges.

  • Reviewing the doctor's employment background and work history.

 

Don't imagine that this is a one-time project. From a medical practice point of view, there is a constant need to be on top of licenses, attestations, hospital privileges, malpractice insurance expirations and payer enrollments, all of which expire and need reverification and renewals.

As you can imagine, this is a long, exhaustive process that takes time and effort. Do you have the staff to handle credentialing and the endless follow-ups?

At 1st Assistant, credentialing is our ONLY business! We are here to take the burden off you and your staff for all payer enrollment tasks and follow-ups. We handle all applications for insurance carriers, inpatient and outpatient facilities, as well as Medicare and Medicaid.

Our cloud-based provider portal offers a secure and easy way to submit documents to us. Once uploaded to our database, we track document expiration dates as well as re-credentialing dates. Outsourcing payer enrollment tasks is the best decision for those practices that want to focus their efforts on what they do best - provide excellent medical services!

Let Our Payer Enrollment Experts Go To Work for You

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.