Physician/Provider Credentialing: What is it and why is it Important?
What is Physician/ Provider Credentialing? Provider credenti aling is the process of compiling and verifying complete informati on about a medical practi ti oner for the purpose of validati ng physician’s experti se and ensuring qualitati ve service to pati ents. Physician credenti aling is a crucial step to get enrolled with any insurance company and claim processing
Process of Physician Credentialing The process of Physician Credentialing is a detailed step by step procedure of collecting, assessing and verifying the Medical Practitioners credentials, documents and certification to ensure the physician meets the standard of quality patient care. Credentialing Applications are to be duly filled with all personal details, contact details and professional work history.
Physician Credentialing Check list Physician’s current updated CV with exact beginning and ending dates of Medical Schooling, Residency, Internship, Work History, career gaps, etc. Board Certifications and Professional school certification
Details of Hospital Affiliation and Privileges Copy Professional License Copy of current State Licenses CAQH and PECOS Credentials Copy of SSN and current Driving License
NPI – National Provider Identification Certification of completion for Internship, Residencies, Fellowship and DEA, CDS and W-9 Form all educational activities including CME’s (Continuing Medical Education) Malpractice Insurance Certificates
Why is Physician Credentialing Important?
Credentialing with Insurance Company is mandatory to enable the physician to be able to see the patients and get reimbursement from the Insurance. Insurance Companies may deny payments for Physicians who are not Credentialing with them. Physician Credentialing is also essential to imply the provider is legitimate and proficient, and showcase integrity to draw patients to your practice. By getting credentialed with a payor, the provider gets increased patient visits from the network which indirectly reflects in improved revenue for the practice.
Who Needs to Get Credentialed and When?
Any physicians who need to send their claims to an Insurance Company and get the reimbursement should get credentialed.
Who Needs to Get Credentialed and When? Listed below the various scenarios which requires the physicians to look out for Credentialing Services . New physician who wish to start seeing patients Providers who are joining a new practice/hospital When switching employers Shifting from one state to another Those who get affiliated to new practices or groups Physician looking to enroll with new payers
Providers are also required to maintain their credentialing privileges by recredentialing on time to ensure the billing process is intact.
Outsourcing Physician Credentialing Services Handling Physician credentialing without any prior experience can be difficult and may lead to multiple miss and rejections. A Medical Practice where one or more physicians are required to be credentialed, will need expertise support to handle and complete the credentialing process on time to ensure their claims are processed timely and cash flow is sustained. It can be laborious and complex for physicians to handle the credentialing by themselves along with daily core of patient care, however with an Outsourced Physician Credentialing things are now easier and stress free.
MGSI – Physician Credentialing Services MGSI has expertise handling credentialing Services with different payers and our Physician Credentialing team are experts in handling each application adequately to meet the elected insurance carrier’s requirements. To know more about MGSI and our services, call 1-877-896-6474 or log on to www.mgsionline.com
Contact MGSI
Your Partner for Medical Billing Services
Phone: 877-896-6474 Website: www.mgsionline.com