The Process of Medical Credentialing

5 min read
15 April 2023

Medical credentialing is an essential part of providing certified healthcare services. It ensures that nurses, doctors, and other healthcare providers have the right education and experience to offer healthcare services to patients. Without medical credentialing, it’s impossible to maintain high service standards.

Healthcare providers and medical practices need to go through medical credentialing in order to stay competitive. Medical organizations and insurance companies verify the credentials and confirm that they have the required licenses, certifications, and skills to provide medical services.

Other names for medical credentialing are physician credentialing and doctor credentialing. Let’s take a closer look at the process.

The Importance of Medical Credentialing

Medical credentialing isn’t just important for the medical service provider. It’s essential for the patients. Here are a few reasons why it’s better not to avoid medical credentialing.

  •       Patient confidence – patients who know that your practice is fully credentialed have more trust in your treatment. They are more likely to choose a clinic that undergoes the extensive process of medical credentialing over a practice that doesn’t. Establishing trust and confidence is key to ensuring the success of treatment.
  •       Professionalism – medical credentialing demonstrates your professionalism to your colleagues. Today, medical credentialing is no longer a complex process. Credential verification organizations (CVOs) make it easy to verify your credentials and demonstrate professionalism.
  •       Career – medical professionals require credentialing in order to speed up the hiring process and improve their chances of achieving the career advancements they need.
  •       Fewer medical errors – the process of medical credentialing encourages medical professionals to obtain the necessary credentials. This improves the quality of service and reduces the chances of medical errors.

By taking advantage of CVO credentialing, you are improving the reputation of your practice, ensuring top-notch services, reducing medical errors and related lawsuits, and much more.

Medical Credentialing Process: Step by Step

The medical credentialing process can vary from organization to organization. If you are working with a reliable CVO, you can expect streamlined processing and convenient credentialing steps.

Application

Each medical facility has a different application. So if a doctor is working for several facilities, practices, and clinics, they would need to fill out a form for each one. The application may be long. Some go over 50 pages. While filling them out can be time-consuming, it’s a significant investment in the medical professional’s career.

Relevant Documents

The doctor needs to attach all the relevant documents that support their skills and permission to work in the field. This may include medical licenses, work history, health documentation, and more. A physician may also need to provide procedure logs.

Verification

Once the doctor submits all the relevant documents and the application, the CVO begins to verify all this information, reviewing work history, checking malpractice history, contacting educational institutions, and more. The goal is to make sure that all the documents are in order.

Many healthcare organizations take advantage of work management platforms that keep track of the staff’s credentials and notify them when anything is about to expire.

Approval

Once the CVO checks all the credentials, they can either award the provider with credentials or refuse to do so. If the check doesn’t discover any negative issues, the physicians receive medical credentials.

Depending on how extensive the checks are, the approval process may take several weeks. The medical practice can help speed up the approval process if they need the doctor to begin working immediately.

Recredentialing

In some cases, the medical practice may decide to grant credentials for a certain period of time. Once this time is up, the doctor may need to go through the medical credentialing process one more time.

It’s important to let doctors know about the expiration date of their credentials ahead of time. This way, they can have all the documentation ready for re-credentialing.

How to Speed Up Medical Credentialing

You can speed up medical credentialing by:

  •       Starting the process as soon as possible and warning the physician in advance so they can prepare all the necessary documentation.
  •       Taking advantage of technology and tools to improve the credential process and reduce errors.
  •       Partnering with relevant organizations to run checks faster and more efficiently.
  •       Making all supporting documents easily accessible online
  •       Going through the application closely and checking for errors.

Working closely with your physicians is key to speeding up the credentialing process. The faster they can provide all the necessary information, the faster you can get started.

Arranging Medical Credentialing for Your Practice

Medical credentialing is an essential part of successful healthcare facility operations. By making sure your doctors have all the necessary credentials, you are improving your reputation, ensuring patient trust, reducing medical malpractice claims, and much more.

While it’s not always an easy process, the return on investment of credentialing is high. It’s a major step toward improving your services and outrunning the competition.

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Alex 9K
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