There are many documents that a medical provider should present to insurance networks, healthcare organizations, and hospitals in order to be allowed to treat patients at a hospital or medical facility. This is what medical credentialing is all about. The documents that the medical provider should present includes his education, training, work history, licensure, regulatory compliance records, and malpractice history. These have to be obtained and evaluated before the practitioner is allowed to participate in a network or to treat patients.


In order to be eligible for a reimbursable expense, a physician or any medical professional must provide a list of verifications to insurance carriers. This is why it is important for any medical office to partner with insurance carriers. 


Medical credentialing verifications vary. They depend on the specifications required by individual insurance carriers and medical facilities. However, most of them would include the following: provider enrollment application, state license, DEA license, education and training board certification, hospital affiliation, and malpractice insurance certificate.


Professional credentialing may take up to 6 months to obtain. And during this period, medical offices should make this one important rule in their financial policy and that is if a medical professional has no proper credentialing, then he is not allowed to perform services.


  You can lose revenues if you don’t obtain proper credentialing. If a professional that has no proper credentialing does service, insurance carriers will not reimburse the medical office that bills them. 


If your medical office allows a professional to perform services before credentialing is complete, there are some insurance carriers that will backdate your reimbursement to cover the services provided. However, there is a limit to this timeframe. If you take the risk, it could cost your medical office thousands of dollars that you could not collect from the insurance payer or the insured. 


Sometimes credentialing because difficult when there are too many doctors in a particular area. They compete for spaces on an insurance company panel. When we speak of the panel it is the list of approved credentialed doctors. But if there are too many doctors on the list, admission and credential may be denied by an insurance company.


It is then important that you submit your provider enrollment packet with any required documentation and verification as soon as possible. This is very important for the success of your medical office.


On the other hand, your medical office should also respond immediately to requests for verification of work history or references for doctors being credentialed by insurers. Otherwise, you could be hindering their credentialing. Discover more at https://www.britannica.com/topic/electronic-health-record#ref1186215.

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