Physicians Credential Services

What is Physician Credentialing?

Credentialing is basically a validation or substantiation of a person’s educational qualification, experience, and their capability in the profession of their choice.

Physician credentialing is basically a formal attestation or evaluation of qualification, skills and the practice history or experience to work in any medical practice or hospital. This has a very positive effect on the profession, the practice can be run smoothly with lesser risks or tensions and this in turn opens up many opportunities, adds to the credibility factor, acts as a career boost and increases confidence levels.

As part of this process, a review of a physician’s educational qualifications, residency, trainings, certifications, papers submitted, researches carried out, if any, or if any malpractice suits or issues are filed or pending are verified and confirmed. Most medical practices, hospitals and even insurance companies requisite this service before enrolling or hiring a physician to their network or practice.

Process involved

  1. Information gathering and checking like the physician’s background, qualifications, personal history, employment history etc.

  2. Verifying all the information from credible sources and organizations

  3. The physician’s specialty, certifications, degrees, gender, location, affiliations and languages spoken are also confirmed

  4. Contacting, the school, college or practice previously employed with

  5. Checking and verifying if any violation, employment breaches, loss of privileges, medical negligence or malpractice suits issues have been reported or registered

Advantages of physician credentialing

Physician credentialing is required when a physician is accepted in a group and is beginning practice, or is moving from one practice to another, or if a medical group or practice is adding a new physician, or if the practice is seeking to become part of an insurance network.

  1. Improved payments- Insurance companies pay credentialed practitioners better especially if they are accepted and recognized by their network. Therefore, doctors do not have to collect more from their patients’ to make up and patients’ claims and payments are approved soon.

  2. Increase in number of patients served- As the physicians are recognized and listed as a preferred group and have acceptance from credible networks, more patients’ choose credentialed physicians.

  3. Better healthcare quality- As thorough background checks and verifications are undertaken as part of the physician credentialing service, the doctors are endorsed and trusted for the service they impart. Also this ensures that there are lesser rackets or frauds involving physician networks and patients.

  4. Liberty to choose the fee structure- With acceptance from the insurance firm with the approved credentialing, physicians can choose a fee structure that is best suited and gainful to them. Also certain plans or models can be determined based on the number of patient visits and consultations.

  5. Easy access to the fee list- The existing fee listing for different services and medical procedures are available to the physicians who are accepted in the network. Accordingly, the physicians can create the billing and submit claims in accordance.

  6. Constructive promoting- With credentialing service done, it can in turn be a form of promoting or marketing of the provider’s practice or physician and it is mutually complimenting to both the physicians and patients. The healthcare practitioner can be chosen based on his credentials and the cost-saving plans his practice or network offers.

Why choose HealthPay Inc. for your physician credentialing services

    • With our credentialing services, accredited physicians will not face problems or issues with regard to denials, eligibility verification, claim submission and reimbursements.

    • Processing the required forms and applications and all forms are submitted online to the federal and other organizations for authentication

    • Ongoing reviews of physicians happen on a regular basis. We follow all the set standards and regulations followed by all the States, regulatory organizations and the NCQA National Committee for Quality Assurance

    • We provide contracted-out credentialing services that include physician enrollment, basic source verifications and revalidation services

    • We work with all the insurance companies and health or medical specialties

    • New Provider memberships and medical practice group pacts

    • Ongoing updations, submissions, informing the insurance agencies and other specialists about the physician, or medical practice or group 

    • Address enrollment issues and also track the status of applications and contracts

    • Information validation, monitoring, enrollment dealings and negotiating changes if required are undertaken

    • Based on acceptance and affiliations, fee schedules, structure and plans and other summaries are updated against individual physicians, the practice or group

    • Reprocessing and reapplying the credentialing documents as and when required on account of time delay, date expiry or a change or addition to the physician’s profile

    • All documentations are processed, recorded and stored electronically online 

    • Experienced and knowledgeable personnel on board to process and service all credentialing applications

    • Quick turnaround period for verifying all the required parameters

    • State-of-the-art software and technology are employed in all the services rendered

  • Clients’ can access their documents and application status online at anytime