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Re-credentialing - Importance

Feb 2nd 2015 at 2:25 AM

The demand for qualified, competent Providers has increased in the US healthcare space in recent times. Before signing partnership, all Payers scrutinize their Providers to make sure if they are truly qualified for practicing medicine independently or under the banner of a healthcare Facility. They label this validation process as Provider credentialing. One key thing that all Providers should keep in mind is that physician credentialing is not a ‘Do once and forget’ process. Providers have to get themselves re-credentialed every year or two as per Payers’ requirements to stay in their preferred provider list and enjoy various benefits. The importance of re-credentialing is illustrated below:

Re-credentialing:

· In addition to the yearly re-credentialing procedure, Providers have the necessity to get re-credentialed when they move from one Managed Care Organization (MCO) to another.

· To substantiate physician credentials, the organization has to check the Provider’s DEA certificate and state license directly from the issuing bodies.

· If necessary, Physician credentialing support databases like National Practitioner Data Bank, Healthcare Integrity and Protection Databank, and Centers for Medicare and Medicaid Services (CMS) may also be accessed to verify a Provider’s credentials.

Significance:

· Although Provider credentialing and re-credentialing processes are time-consuming, it is essential that every Provider follows them. Only through these processes can the US healthcare space be sure that patients have access to qualified physicians. Thus, quality of care is ensured for all patients.

· The Physician credentialing process allows Providers to enjoy special privileges, which are offered by Payers based on the qualification, medical training, medical history, skill levels and prior malpractice status. To continue enjoying such benefits, re-credentialing is a must!

· Providers who are credentialed and re-credentialed with special privileges receive higher reimbursements which are also paid faster. Therefore, to enjoy such benefits, they must get re-credentialed on time, every time!

· They also have the advantage of choosing the desired fee schedule corresponding to various clinical procedures and services to get a better income. Provider re-credentialing would highly help Providers enjoy this benefit.

· Above all, patients prefer credentialed Providers to non-credentialed ones since patient responsibilities are smaller. They consider Physician credentialing as an important qualification and seek out in-network Providers for their care. Therefore, to enjoy the maximum benefits from their contracts, it is important that Providers re-credential themselves every year or two or based on the payers’ requirements.

Need help?

Many outsourced medical billing companies do not provide credentialing and re-credentialing services to their clients. They only offer the core medical billing services rather than these specialized services. e-care is an exception in that it provides exceptional credentialing and re-credentialing services in addition to the core activities.

About e-care India:

e-care India has 15 years of experience in the industry. e-care’s 3 offshore medical billing delivery centers have been providing credentialing and re-credentialing, end-to-end medical billing, denial management and medical coding services seamlessly to its clients. To know more about e-care and its services, log on to www.ecareindia.com.

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