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Credentialing Process| Ought To Be Done Way Ahead

Credentialing is a process of gathering, verifying and evaluating the qualifications of a practitioner by the Insurance provider before providing care or consultation privately or in a health care organization.

Importance of Credentialing

The process of credentialing must be started when a health care organization brings on a new provider. They must send in the application to the insurance company and get the approval before the new provider starts seeing patients. In case the health care organization allows the provider to see the patients without being credentialed, the chances are that the claims will be denied creating confusion and trouble to the patient, doctor, health care organization, insurance company and other staff.

How it is done?

Credentialing is a time consuming process and insurance companies take about 90 to 180 days to process an application and provide approval. Before starting the process, the health care organization will be registered with CAQH which is one the platforms that most insurance companies use. At CAQH, the health care organization must self-register the new practitioner’s demographics, academic details, work experience, malpractice history, and other relevant information for insurance companies to access for credentialing. However, it needs to be re-attested every 120 days and the CAQH will notify the provider when it needs to be done.

The health care organization or the practitioner need to make sure that all the information such as phone number, address, email, CV, diploma, reference letters and other documents need to be accurate. The insurance company will be calling to verify the information. In case of missing or fraudulent information or documents, the process will be further delayed.

In order to simply the credential process, the health care organization or practitioner can check with the insurance provider if they will allow processing the application online. However, this varies from state to state in the US.

Whether you are a small or a large practice, Vanan HealthCare can provide you with a free consultation to check if there are any areas that need improvement.

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