Eight Questions to Ask a Medical Credentialing Services

Credentialing is a complex process that requires extra time & care, there come the concept of Medical Credentialing Services specifically for Medical Credentials Validations.

One mistake and can cause a temporary stop to your revenue management cycle.

There are chances that you might come across problems while credentialing no matter if you have done this before or not.

One reason for that is the constant change in healthcare guidelines regarding credentialing.

If you are confused or have questions about the credentialing process, you are not alone.

The good thing is there are ways to minimize those problems.

Below we provide a list of ten questions that you should ask a credentialing service provider to better understand the process and minimize basic credentialing issues.

What is the Different between Provider Enrollment and Provider Credentialing?

First, you need to know the difference between credentialing and enrollment.

These two words are used in place of one another very commonly by the healthcare providers, however, there are significant differences between these two that you should know.

A provider credentialing is the process of verification of a provider by thoroughly analyzing and assessing their qualification while on the other hand in provider enrollment the healthcare provider goes through the process of seeking reimbursement for the medical services it provides to the patients.

Should the Provider be enrolled or credentialed first in the Health Plans?

It is important to know the process of medical credentialing services in an orderly manner to make the process easy for both you and the patient.

You need to enroll in the health plans first, which does not allow the providers to the bill after the services have been provided.

If the healthcare plan allows the billing of the services provided by the provider before credentialing, then you should enroll it last.

How to Stay Organized During the Credentialing Process?

Medical credentialing services are a complex process which means there are chances of it being messy.

This can lead to the missing of deadlines and extra work for the provider. There are ways to tackle this problem.

First things first, you should make a detailed list of the entire process including the due dates.

You can use a tracking system to do that. There are many software systems that providers use for this purpose.

It is important to first get to know the benefit of software before spending money on it.

Take advice from other people and organizations who might have experience with the software.

Also, do a thorough comparison of the different software systems to make sure you are spending money on the best one.

Also Read: When Should You Go For A Skin Cancer And Mole Check?

What is the best way to stay up to date with the new credentialing developments?

The rules and regulations for credentialing are changing continuously and so is the process to include the new changes.

To stay updated about the new credentialing developments you should subscribe to new payer sites online, be part of different services groups on social media sites.

Always stay connected with hospitals and insurance providers.

Make a list of contacts that you can reach out to whenever you need to find out about any new developments and share it with your staff.

What to do when a Provider has an Irregular Record?

This is an alarming situation, and you should keep a close eye on it.

One thing to do is to keep the application under observation and slow down the process if necessary.

It usually happens when a provider has studied from a foreign country; hence it takes time to verify the process.

How to find any red flags in a pro ides record?

Several things might point towards red flags in the application form and can make the provider stand out.

Some of those red flags could be more than usual gaps in the mandatory training programs, too many claims of malpractice against the provider, too many job changes, claims of lack of discipline, and many more.

The provider should be able to clarify all the red flags to get credentialing.

Giving the organization a heads-up about the provider’s situation is also another good idea so that they know in advance about any delays in processes.

How to Make Sure the Providers get credentialed quickly?

The most important thing to do is to make sure you fill out the application form because if you leave out any question it can slow down the entire process.

Secondly, make sure the date and spellings are correct as these are the two common mistakes that providers do.

Another tip is to communicate the process and everything that is required to fill out the form to everyone involved.

Ask for as much relevant information as possible and thoroughly review the application before you submit it to the health plan or hospital to avoid any errors.

Make sure to follow the guidelines and standards provided.

It is also significant to review all the documents and CVs to make sure they are attached to the application before submitting them.

What to do while closing a location of Practice?

You must cancel your enrollment with the health plan before changing your location.

This is for safety as there are chances of someone else might bill those plans.

Someone gets hold of your confidential information and bill it under your organization creating problems for you.

These are some basic questions you also ask a credentialing service to make sure the process is as smooth as possible.