PROVIDER CREDENTIALING BASED ON INSRANCE PLAN REQUIREMENT…

An investment that allows your provider to begin billing and pulling in revenue faster. Provider credentialing an essential part of making sure your practice gets paid. If a doctor in your practice isn’t credentialed, then insurance carriers will not reimburse them. Insurance carriers do not reimburse medical offices that bills for services or professionals who have not been properly credentialed.Medicaid plan, Medicare, or insurance company, you may not get paid unless out-of-network benefits are available to that patient. Unfortunately, sometimes the actual credentialing process can be time-consuming and frustrating for everyone involved. However, there are a few ways that you can simplify the process while avoiding rejections and saving time. Modern day credentialing is far more complex and the process more error prone. Read on to discover the convoluted, yet crucial, world of medical credentialing. A process that examines and reviews the health care provider's qualifications and career experience including education, medical certification, training, licenses held and any specialty certificates to determine if clinical privileges to practice in a particular place can be granted. It must be completed upon the hire or enrollment of a new doctor and regularly afterwards to abide by the standards set forth by regulatory and accreditation organizations such as the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC).