CAQH (Council of Affordable Quality Healthcare) implemented a virtual care directory Taskforce in late 2020 to provide sufficient data for virtual care. A health plan could use a framework document to implement changes for virtual care information.

Credentialing audits are the method of validating and evaluating a health provider’s qualifications, which include education, career history, training experience, residency and permits, specialty certificates (if any), and other certification details. It is the main process for a healthcare provider and a key to ensuring that all the information is current. 

Provider credentialing is the process of obtaining and reviewing the provider information to issue hospital membership and other privileges. The credentialing teams will audit the provider’s licensure, training and work history, certification, and other necessary information.

Credentialing certificate will showcase the provider’s expertise in his specialized department. Patients will prefer to visit a healthcare provider whose credentials are certified. It is more applicable for specialty-based providers. 

Medical credentialing is becoming imperative because it allows patients to build trust with their healthcare provider’s expertise. Patients feel secure and satisfied after reviewing the merit and experience of their medical professional through a standardized process that includes data collection, essential source confirmation, and panel auditing by hospitals and other healthcare organizations. Below are some of the benefits of doing a ‘credentialing audit’

Credentialing Audit plays a vital role in the healthcare marketplace because stakeholders are looking for cost-effective ways to ensure patient safety. Examining the qualifications and experience of healthcare professionals could save healthcare organizations from a variety of liabilities, compliance violations, and unfavorable lawsuits.

Comparatively, Provider Credentialing and Provider Enrollment are similar in many different ways. Healthcare providers must complete this procedure before treating any new patients. 

As already mentioned, Provider Credentialing is the process of collecting and verifying provider information. Insurance payers will utilize this credentialing data to enroll the certified providers in their systems.

For provider credentialing the below information are required:

The process of provider enrollment is similarly related to the process for provider credentialing. While provider credentialing ensures provider credentials are validated, the healthcare providers can start enrolling with the insurance payers and negotiate contracts accordingly. To complete the enrollment process, insurance payers will require the same information that was given for provider credentialing.

The most annoying of all is the fact that most payers will force you to restart the application process if you make any errors on one of the forms you submit – no matter how little the error may be.