The Medical Credentialing Process: Improving Process Efficiency

credentialing process checklist

 One of the many challenges of starting a new practice, scaling, or recruiting new personnel lies in getting medical providers billable as soon as possible. And as almost everybody that ever went through the process can attest, the medical credentialing process is tedious and resource hungry.

According to a survey conducted by the National Association of Medical Staff Services (NAMSS), the average time for initial credentialing is approximately 60 days, while re-credentialing can take 45 days on average. But it’s not unheard of that the credentialing process may take up to 90 days and in some extreme cases, even 120 days. 

In this article, we’ll discuss what medical credentialing is, the different types of credentialing, the challenges of medical credentialing, the seven steps to expedite the medical credentialing process, and the benefits of outsourcing medical credentialing.

What is Medical Credentialing?

Medical credentialing is the process of verifying a healthcare professional’s qualifications, work history, and competency to ensure they meet the necessary standards for patient care. The credentialing process involves verifying the healthcare professional’s education, training, licensure, board certifications, and work history. 

The primary objective of medical credentialing is to ensure that healthcare professionals are qualified to provide high-quality care and reduce the risk of malpractice.

To participate in the Medicare program, healthcare providers must be enrolled in the Medicare system and have a National Provider Identifier (NPI) number. To enroll, healthcare providers must complete an application with information about their credentials, licensure, and experience.

Similarly, to participate in the Medicaid program, healthcare providers must be enrolled with the state Medicaid agency and meet the state-specific requirements for credentialing.

medical credentialing process

What are the Main Types of Medical Credentialing?

There are different types of credentialing, including:

  • Initial credentialing, 
  • Re-credentialing, 
  • and provisional credentialing

Initial credentialing is the process of verifying the qualifications and background of new healthcare professionals before they can start practicing in a healthcare organization. 

Recredentialing is the process of verifying a healthcare professional’s qualifications and work history every few years to ensure they still meet the necessary standards. Provisional credentialing is the process of providing temporary credentials to healthcare professionals who are new to a healthcare organization.

What Challenges Comes Along with the Medical Credentialing Process?

The medical credentialing process can be complex and time-consuming. One of the challenges of medical credentialing is incomplete information. It can be challenging to obtain complete information about a healthcare professional’s education, training, work history, and board certifications. 

Another challenge of medical credentialing is the credentialing process itself, which can be lengthy and cumbersome. The process involves completing credentialing applications, verifying primary sources, and obtaining peer references.

7 Steps to Improve the Medical Credentialing Process

The medical credentialing process is already time-consuming and frustrating. The last thing you want is to extend it even more. That’s why paying attention to the following seven steps is essential to ensure that your credentialing process consumes the least time.

1. Identify the Required Credentials

Identifying the required credentials is crucial in ensuring that healthcare professionals meet the qualifications for their roles. It involves determining the specific education, training, licensure, and other requirements needed to practice in your healthcare organization.

2. Gather Necessary Information

Gathering necessary information involves collecting all required documentation and verifying the healthcare professional’s work history, licensure, education, and board certifications. It is essential to have complete and accurate information to ensure the credentialing process is successful.

3. Verify Primary Sources

Verifying primary sources is a critical step in the credentialing process as it ensures that the information provided by the healthcare professional is accurate and reliable. It involves obtaining information directly from primary sources such as licensing boards, medical schools, and previous employers.

4. Use a Centralized System

Utilizing a centralized system to manage the credentialing process helps to ensure that all necessary documents are received on time and deadlines are met. It provides a streamlined approach to managing the entire process and allows for efficient communication between all parties involved.

5. Utilize Technology

Utilizing technology can automate some parts of the credentialing process and reduce the time needed. For example, electronic verification of licensure and board certifications can speed up the process significantly.

6. Prioritize the Process

Prioritizing the credentialing process ensures that other competing priorities do not delay it. By giving the process the necessary attention and resources, it can be completed promptly and efficiently.

7. Follow Up Regularly

Following up regularly with the healthcare professional and all relevant parties is essential to ensure the process stays on track and meets all deadlines. Communication is vital, and regular check-ins help to ensure that any issues are resolved quickly, and the process stays on schedule. For many healthcare organizations, this step is the biggest culprit when it comes to delays. In-practice administrative employees are caught up in daily activities and do not have the capacity to play a police officer and schedule and do regular check-ups.
credentialing process

Elevate Patient Care and Boost Revenue
with Neolytix Rev+ Program

Empower your practice to elevate patient care while optimizing revenue

What are the Benefits of Outsourcing Medical Credentialing?

Outsourcing medical credentialing services can provide several benefits to healthcare organizations. One of the benefits is that it can help reduce the burden on healthcare organizations and free up resources to focus on patient care. Outsourcing can also help ensure the credentialing process is completed accurately and efficiently. 

Additionally, outsourcing medical credentialing  can provide access to specialized expertise and technology that can help streamline the credentialing process.

Neolytix has mastered the medical credentialing process over more than eleven years of servicing healthcare practices of all sizes nationwide.

The range of credentialing-related services we offer also includes but is not limited to:

  • CAQH registration and attestation,
  • Medicaid managed care organization credentialing,
  • Fee schedule negotiation,
  • NPI registration,
  • SUD/IOP credentialing
  • Medicaid credentialing
  • Medicare credentialing

If you are considering outsourcing provider credentialing services, please get in touch with us at Neolytix.

Call us today to discuss your organization’s unique enrolment and credentialing challenges and how we can help streamline the process.

Get a No Obligation Quote for Medical Credentialing

 One of the many challenges of starting a new practice, scaling, or recruiting new personnel lies in getting medical providers billable as soon as possible. And as almost everybody that ever went through the process can attest, the medical credentialing process is tedious and resource hungry.

According to a survey conducted by the National Association of Medical Staff Services (NAMSS), the average time for initial credentialing is approximately 60 days, while re-credentialing can take 45 days on average. But it’s not unheard of that the credentialing process may take up to 90 days and in some extreme cases, even 120 days. 

In this article, we’ll discuss what medical credentialing is, the different types of credentialing, the challenges of medical credentialing, the seven steps to expedite the medical credentialing process, and the benefits of outsourcing medical credentialing.

What is Medical Credentialing?

Medical credentialing is the process of verifying a healthcare professional’s qualifications, work history, and competency to ensure they meet the necessary standards for patient care. The credentialing process involves verifying the healthcare professional’s education, training, licensure, board certifications, and work history. 

The primary objective of medical credentialing is to ensure that healthcare professionals are qualified to provide high-quality care and reduce the risk of malpractice.

To participate in the Medicare program, healthcare providers must be enrolled in the Medicare system and have a National Provider Identifier (NPI) number. To enroll, healthcare providers must complete an application with information about their credentials, licensure, and experience.

Similarly, to participate in the Medicaid program, healthcare providers must be enrolled with the state Medicaid agency and meet the state-specific requirements for credentialing.

medical credentialing process

What are the Main Types of Medical Credentialing?

There are different types of credentialing, including:

  • Initial credentialing, 
  • Re-credentialing, 
  • and provisional credentialing

Initial credentialing is the process of verifying the qualifications and background of new healthcare professionals before they can start practicing in a healthcare organization. 

Recredentialing is the process of verifying a healthcare professional’s qualifications and work history every few years to ensure they still meet the necessary standards. Provisional credentialing is the process of providing temporary credentials to healthcare professionals who are new to a healthcare organization.

What Challenges Comes Along with the Medical Credentialing Process?

The medical credentialing process can be complex and time-consuming. One of the challenges of medical credentialing is incomplete information. It can be challenging to obtain complete information about a healthcare professional’s education, training, work history, and board certifications. 

Another challenge of medical credentialing is the credentialing process itself, which can be lengthy and cumbersome. The process involves completing credentialing applications, verifying primary sources, and obtaining peer references.

7 Steps to Improve the Medical Credentialing Process

The medical credentialing process is already time-consuming and frustrating. The last thing you want is to extend it even more. That’s why paying attention to the following seven steps is essential to ensure that your credentialing process consumes the least time.

1. Identify the Required Credentials

Identifying the required credentials is crucial in ensuring that healthcare professionals meet the qualifications for their roles. It involves determining the specific education, training, licensure, and other requirements needed to practice in your healthcare organization.

2. Gather Necessary Information

Gathering necessary information involves collecting all required documentation and verifying the healthcare professional’s work history, licensure, education, and board certifications. It is essential to have complete and accurate information to ensure the credentialing process is successful.

3. Verify Primary Sources

Verifying primary sources is a critical step in the credentialing process as it ensures that the information provided by the healthcare professional is accurate and reliable. It involves obtaining information directly from primary sources such as licensing boards, medical schools, and previous employers.

4. Use a Centralized System

Utilizing a centralized system to manage the credentialing process helps to ensure that all necessary documents are received on time and deadlines are met. It provides a streamlined approach to managing the entire process and allows for efficient communication between all parties involved.

5. Utilize Technology

Utilizing technology can automate some parts of the credentialing process and reduce the time needed. For example, electronic verification of licensure and board certifications can speed up the process significantly.

6. Prioritize the Process

Prioritizing the credentialing process ensures that other competing priorities do not delay it. By giving the process the necessary attention and resources, it can be completed promptly and efficiently.

7. Follow Up Regularly

Following up regularly with the healthcare professional and all relevant parties is essential to ensure the process stays on track and meets all deadlines. Communication is vital, and regular check-ins help to ensure that any issues are resolved quickly, and the process stays on schedule. For many healthcare organizations, this step is the biggest culprit when it comes to delays. In-practice administrative employees are caught up in daily activities and do not have the capacity to play a police officer and schedule and do regular check-ups.
credentialing process

Elevate Patient Care and Boost Revenue
with Neolytix Rev+ Program

Empower your practice to elevate patient care while optimizing revenue

What are the Benefits of Outsourcing Medical Credentialing?

Outsourcing medical credentialing services can provide several benefits to healthcare organizations. One of the benefits is that it can help reduce the burden on healthcare organizations and free up resources to focus on patient care. Outsourcing can also help ensure the credentialing process is completed accurately and efficiently. 

Additionally, outsourcing medical credentialing  can provide access to specialized expertise and technology that can help streamline the credentialing process.

Neolytix has mastered the medical credentialing process over more than eleven years of servicing healthcare practices of all sizes nationwide.

The range of credentialing-related services we offer also includes but is not limited to:

  • CAQH registration and attestation,
  • Medicaid managed care organization credentialing,
  • Fee schedule negotiation,
  • NPI registration,
  • SUD/IOP credentialing
  • Medicaid credentialing
  • Medicare credentialing

If you are considering outsourcing provider credentialing services, please get in touch with us at Neolytix.

Call us today to discuss your organization’s unique enrolment and credentialing challenges and how we can help streamline the process.

Get a No Obligation Quote for Medical Credentialing

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