Physician credentialing is the process of enrolling a physician with the insurance company to ensure the physician is privileged to provide services to the patients and get their claims processed with that particular payer. Physician Credentialing is essential for the physicians to be “In-Network” with various government and commercial insurance companies which can help increase patient referrals and overall revenue. Let us look in detail on how to avoid Credentialing Pitfalls from impacting your revenue.
Plan ahead of time
Credentialing might seem to be an easy and simple process of paper works but the reality is, Physician credentialing if not done on time with accuracy can ultimately impact your revenue. Thus planning the requirement of physician credentialing process ahead of time is quintessential on any of the below scenarios, but not exclusive of
- The medical practice is adding a new physician
- The physician is starting to practice for the first time after medical graduation
- A physician wants to get enrolled with a new payor
Physician Credentialing Document Checklist
The common cause of delays in Physician Credentialing is the submission of incorrect, incomplete or missed detail or supporting documents. To avoid such a miss, it is recommended to have a Payor-based checklist of required data and supporting documents that need to be attached with the Physician Credentialing Application. Almost all insurance companies require the physician’s qualification, certification and work-related data to credential the physician in their network. Pls. see below a common checklist of documents to be submitted along with credentialing application
- Physician personal details like Name, Age, DOB, Gender, SSN, etc.
- Contact details like Mailing Address, Phone number, Email Id
- Copy of Driving License
- Practice details like – Tax Id, Practice contact details, Provider NPI
- Providers Educational and training Certification
- Residency and Internship Certification
- Continuing Medical Education (CME) documents
- Copy of current state licenses
- CAQH Credentials
- Hospital Affiliations
- Work History with an explanation on career gap
- Malpractice Insurance
- Previous Malpractice History with status
- Peer References
Complete and Accurate Documentation
Incomplete and inaccurate application and supporting documents can lead to unnecessary delays. Therefore it is indispensable to deploy experienced staff to handle credentialing process along with a streamlined and timely process to ensure quality. Performing audits on regular basis can help identify the common reasons for repeated errors and delays and implement corrective measures.
Regular Follow-ups
Physician Credentialing can take anywhere from 90 to 120 days to process. Insurance companies handling numerous applications on a day to day basis may miss out on your application, hence it is crucial to have regular follow-up with the insurance company to ensure timely processing of your application.
Experienced Staff
Handling paper works for physician credentialing requires deft hands and making regular follow–ups requires a team with expertise on understanding the nuances of each payer. An experienced staff can handle the core with accuracy to ascertain the quality and timely process of credentialing. Outsourcing Physician Credentialing is mostly opted due to the intricacy involved in handling the process and to ensure quality work by a professional and experienced team.
About e-care
e-care India is one of the pioneers in offshore medical billing based in India that promises to avoid the revenue pitfalls due to incomplete or delayed Physician credentialing by its services. With 20 years of experience in the industry, e-care’s 3 delivery centers have been providing Medical Billing and Physician Credentialing services seamlessly to their clients. To know more about e-care and its services, contact us today at 813-666-0028 or log on to www.ecareindia.com