Physician Credentialing & Provider Enrollment: The Need-To-Knows
Physician credentialing processes can be observed in medical facilities like assisted living homes, doctor’s offices and laboratories. The process that involves the collection of crucial information that attests to the credentials and competency of a medical service provider is called credentialing.
The agencies that oversee the credentialing process make use of the latest background checking technologies. Medical providers must go through a credentialing process before they are hired by medical facilities and insurance companies. When it comes to this process, the physician or medical practitioner is verified for his or her licensure status, trainings, quality of service, educational attainments and general ethical standing within the medical community.
A physician is asked to provide supporting documents that can attest to their credentials in order for things to run smoothly. The process zeroes in on the areas discussed below:
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Educational Attainment – a medical practitioner’s school and post-graduate training are double checked.
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Board Certification – medical service providers are checked whether or not they underwent legitimate and relevant trainings.
Licenses – cross checking of a physician’s licensed is done.
Background Check – doctor’s are investigated for the presence of a criminal history.
Malpractice Claims – any instances of malpractice with be verified through this.
Malpractice Insurance – doctors are checked if they have the right kind of insurance.
Privileges – hospitals where physicians practice are verified.
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An appointed panel of physicians is required to verify all the documents presented. These panels advise with regard to a medical service provider’s ethical standing and professionalism in his or her community. The committee with decide if the doctor has been an upstanding member of the medical community.
Insurance firms will then evaluate the achievements and credentials of a medical service provider before accepting him or her into their roster of participating practitioners. All doctors must go through the approved verification process before insurance companies allow them to bill their patients. Unevaluated medical practitioners are also not allowed to be associated with assisted living facilities. Even the private medical sectors require every doctor to go through a thorough credentialing process so that they can be sure that they will provide nothing short of the best services available.
Once a physician is evaluated by his or her peers, the patients can be sure that they are getting only the best care available. The credentialing process enables the patients to be more confident with their medical practitioners and the services they offer. Doctors keep their credentials up to date by adhering to their credentialing committee’s set of rules and regulations.
Some companies specialize in medical service provider credentials. Credentialing companies associate with service practitioners and medical facilities in order to keep their records and credentials up to date.