Medical credentialing is a crucial and necessary step to having an operating practice. This process encompasses the actions required to review doctors’ qualifications and career history. Credentialing takes a close look at the education, training, residency, and licensing of a medical professional while also identifying any of the certificates one may have obtained.
Because this step into the professional medical industry is so important, it is vital to have your credentialing performed by the right service.
There are many different options out there in terms of credentialing, so it can be a little difficult to know for certain that you are using the right one. Follow this brief guide to choosing a medical credentialing service that’s right for you.
Why is Credentialing Important?
The process of credentialing is important because it establishes a doctor’s or a team of doctors’ qualifications. If an individual or a practice is credentialed, it means that a board of qualified personnel has deemed them legitimate.
At the same time, physicians and other healthcare providers cannot work with insurance companies if they are not credentialed. When you receive your credentialing, you gain access to in-network providers. With this access, you can work with insurance companies and send bills their way.
Credentialing also means that insurance companies have verified the medical provider’s training, education, etc.
How to Choose a Service
Whether you are looking to be individually credentialed or are trying to credential a small provider to as large as a hospital, choosing the right service can make or break this complicated process for you. These are just a few things that you should consider before you choose your service:
Let’s take a closer look at each other these considerations.
The amount of experience a credentialing service has is very important. Since this process is so complicated, you want someone who knows what they are doing. In most cases, someone who has been practicing the same thing over several years typically has it nailed down.
The credentialing service you use should have in-depth knowledge and skillful experience worker with all kinds of providers. They should know about state-specific payers and have the best service—meaning they communicate well and know when to follow-up.
Experience also means that this service has established strong business relationships with payers. This can help them maximize your application process as well as speed up the procedures. Your service should be able to answer any question to have relating to credentialing in the snap of a finger.
Reliability and experience go hand-in-hand. You can have an extremely experienced company, but if they aren’t reliable, then they are pretty much useless to you. At the same time, what’s a reliable company with zero experience?
When choosing a credentialing service, you are choosing a partnership. Like any other business partnership, you don’t just choose the first one you meet. A credentialing service may look good based on their website, but in-depth research is necessary to make sure you have someone who is going to have your back.
Remember, this is your career; it’s of the utmost importance.
You can often tell a company’s reliability by the way they communicate. Do they answer your phone messages and emails promptly? Are they quick to find answers to your questions? Do they show up to every meeting, or do they often cancel or reschedule?
Figure out a service’s personality and make sure you mesh well with them.
You want a credentialing service that has the best and most recent technology. When outdated technology comes into play, you risk unreliable services and application software. The software is very important to the application process.
The best credentialing services will have cloud-based systems. These systems are ideal because they not only offer better analytics, but they use portals for easy and accurate data entry and access to a multitude of stakeholders.
Every medical practice and individual professional are different with various needs. If you’re a first-timer, you may not already know that the one size fits all method doesn’t quite work when it comes to this process.
The best credentialing services can offer organizations a customized approach. These services know that everyone is unique and has different backgrounds and goals, so they have to adjust accordingly.
Communication comes into play again here big time, because a good credentialing service will take the time to get to know you or your practice. They will go the extra mile to meet your needs and give you the answers specific to your situation.
Cost is always the wildcard when it comes to credentials. While some people may be very concerned about costs, it’s also important to remember that cost isn’t everything. Since credentialing is so vital to a medical professional’s career, sometimes it’s okay not to be worried about the price tag.
A low-cost credentialing service can certainly be tempting—we’ve all been there: a low cost can make us buy almost anything—however, you often get what you pay for.
Don’t be afraid to spend the money on your credentialing. Getting the quality services you need is how you will jumpstart your career. And the value of a successful career in the medical field is priceless.
Finally, a great way to get a good, honest snapshot of a company is by reading reviews. Nowadays, there are reviews for absolutely everything on the internet. Some credentialing sites will even have a section right on their page for customer reviews.
However, it can be hard to know which reviews they actually post, so we recommend looking for reliable blogs and review sites to find truthful no-holding-back information.
You’d be surprised to see how many people take the time out of their day to post a long, detailed review about these things—or anything.
At the same time, remember that everyone has a different experience. While reviews can be very helpful in the decision-making process, they are only one step. Do your own research—don’t just rely on the research and experience of others.
Mistakes to Avoid
As with many other application processes, there are common mistakes that many people make. It’s not necessarily the end of the world, but these mistakes only serve to slow down the credentialing process rather than keep it quick and simple.
Here are a few things you should try to avoid doing during your credentialing process:
- Incomplete applications
- Poor Technology
- Slow Response Time
- Disregard for Industry Standards
We’re going to expand on these mistakes a little bit to help you further understand what we are talking about.
Applicants for credentialing must submit a number of forms and a variety of paperwork. Aside from the general application form, you have to include things like a POI form, a copy of your malpractice insurance policy, your resume, reference letters, photo ID, and much more.
If you are not careful, it can be pretty easy to let one of these items slip. When you forget to include something on your application or in your application process, it elongates the entire credentialing process.
Not only does your credentialing service have to sort through your application carefully to identify what you have forgotten, but they then have to reach out and make contact with you. You then have to submit the missing information so they can recheck everything all over again.
By being extra scrutinous and thorough the first time around, you can cut down your turnaround wait time.
The existence of poor technology obviously isn’t your mistake. However, as we discussed earlier, it is up to you to choose a credentialing service that has the most up to date software.
By selecting the right service to work with, you can cut down on turnaround time.
Updated systems and software mean a smoother transaction in terms of applications and data. Make sure you’re only looking at companies with great technology, and you can eliminate that source of delays.
Slow Response Time
This mistake is a two-way street. Both you and your credentialing service need to have timely responses to one another. Again, this, in part, goes along with choosing the right service.
At the same time, if you have a service that is dedicated to helping you and providing the best customer service with quick responses, it is your responsibility to be equally as efficient. You should be on top of any emails or phone calls you get from your credentialing service, as they may need additional information or have vital questions for you.
Don’t put off anything during your credentialing process. It will only delay your application approval.
Disregard for Industry Standards
The medical profession has high standards and strict policies, and for good reason. Your failure to keep your documents updated will certainly hinder your credentialing services. It is crucial for healthcare providers to keep all of their licenses and certifications up to date at all times.
Renewing your license and credentials is not something you can put off like renewing your driver’s license.
Not only can delaying in renewals slow down any credentialing you have to do, but it can result in malpractice lawsuits and greatly affect your practice’s reputation.
Questions to Ask a Credentialing Service
Looking for a credentialing service can sort of be like an interview process. It’s their job to convince you why they’re your best option. They most certainly already have some kind of sales pitch prepared, but it’s up to you to ask the right questions. Use some of these questions to determine if a service is right for you:
- Do you service practice credentialing, individual credentialing, and organizational credentialing?
- This question is important based on what you’re looking for. If you want to be individually credentialed, but a service only specializes in practice credentialing, they may not be the best choice for you.
- What are your fees and claim percentages?
- Before you agree to anything with a credentialing service, you should be aware of any fees or costs you will encounter. This is also a good time to check and see how upfront a company is with their information.
- What kind of software do you use?
- Even if you aren’t “in the know” on credentialing software, you can always do a quick internet search when a company answers this question. That way, you can know if a company is up to date on their technology for the best service.
- Does your technology involve the use of smartphones?
- This question goes hand-in-hand with technology and software. Everyone uses their smartphone for everything these days. If you’re able to submit documents, sign paperwork, and receive notification reminders all on your phone, then you’re working with a good company.
- What is your review and negotiation process like?
- Your credentialing firm will be the one to negotiate any new agreements your practice makes with insurance companies. You need to make sure they are willing to negotiate with your best interest at heart rather than accepting the first offer.
- Does your company have any references?
- Just like a company hiring you may ask for references, you may want to check out some references to a credentialing service. This can reassure you of their previous work experience and whether or not they are a trusted service.
Credentialing: You Can Do It!
Medical credentialing is not easy. If it were, everyone would be in the business. However, as we’ve learned today, there are steps you can take to make it more bearable. Choosing the right credentialing service can make a world of difference and save you a bad headache.
Take your career into your own hands by making smart decisions during your credentialing process.