What Is Physician Credentialing?
Credentialing is known as the act of gathering information which is related to a doctor or medical provider to determine their qualifications to practice medicine in their specified specialty.
Various agencies provide Physician insurance credentialing services. Some of the credentialing agencies are the leading agency that monitors the credential and qualification standards in health care. Medical providers should go through a credentialing process before they are supposed to be hired by medical facilities and insurance companies. But when you are going for Physician credentialing the question which comes in mind is how many physicians credentialing services cost, we want to let you know that cost of these services is not very much. As these credentialing will only verify licensure, education, quality, training, and overall ethical standing of the provider in the medical community.
The doctor's credential procedure starts with the medical provider as they submit your information to the credentialing agency for review. Areas for which information is gathered are -:
· Education – They will verify your medical school and any post-graduate training
· Certification- Specialty certification and training
· Licenses - Which licenses does a doctor have
· Background Check - Any criminal record is researched
· Malpractice Insurance – Making sure that appropriate levels of insurance should be available.
· Privileges -Hospitals where physician practices
· Resume detailing work history
A physician peer-review committee reviews the information which is provided by you and gathered by the credentialing agency. These committees make the required decision related to the professionalism and standing of the provider within the medical community. There are chances that committees will evaluate the ethical behaviour of the medical provider.
Insurance companies, which includes the government-sponsored payers, will do various research related to the medical credentials of a physician before accepting her or him into their group. Medicaid and Medicare will not allow these physicians who have not gone through the required credential procedures to bill for services. Managed care organizations also have a very strict physician credentialing procedure before a provider can be listed as with the insurance company. Various private physician practices also credential their doctors to make sure about quality delivery of care.
Provider credentialing is one of the ways of assuring consumers that medical providers have been verified by their peers. It helps them to enhance the level of trust and makes sure that the provider is licensed and Board Certified and has not had any fake licenses and has all the required qualification.
