Patients often know limited details about their physician’s qualifications. Medical credentialing is increasingly essential as it is the one procedure that allows patients to confidently place their trust in their chosen healthcare providers. At CodeMax, we pride ourselves on providing top-tier professional consulting services that enable our clients to focus on providing the best possible service to their patients.
What is Medical Credentialing?
Medical credentialing is a meticulous review process of a health provider’s qualifications. This often includes:
- Career history
- Proof of residency
- Certificates confirming specialties
Credentialing is typically checked right before or when a provider is hired, and this information must always be accurate and current.
To ensure credentials remain current, medical credentialing is repeated multiple times throughout a career. It must follow and match all standards and rules established by the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC). This often provides a source of frustration as it can be time and labor-intensive, as well as tedious and costly.
Staff often do not have the time or resources to devote to medical credentialing. For these reasons and more, working with a quality consultant like CodeMax can take this weight off your shoulders.
What is Commonly Needed to Confirm Credentials?
Part of the reason why medical credentialing is so time-intensive is that there is a laundry list of documents that need to be managed and kept up to date. These include the following and more:
- Proof of Identity
- Government-issued photo identification
- NPI number
- I-9 documentation
- VISA or Employment Verification card
- Education and Training
- Proof of course completion and completion dates
- Fellowship enrollment
- Clinical degrees
- Explanation of any time gaps
- Professional Licensure
- Issuing state
- license type
- license number
- issue and expiration dates
- Board Certification
- Full list of Board-specialty certifications held
- Includes original, recertification, and expiration dates
- Affiliation and Work History
- Chronological, comprehensive list of all facilities in which the provider has worked or had clinical privileges
- Criminal Background Disclosure
- Health Status
- Malpractice Insurance
- Comprehensive list of insurance carriers
- Includes coverage dates and types
- Current certificate of insurance
Why Medical Credentialing Matters
Medical errors are responsible for the death of nearly 100,000 Americans each year. Enhanced standards of competency and calls for disclosure of recorded disciplinary actions against healthcare workers are ways of fighting back against poorly trained or ineffective medical practitioners.
Transitioning from manual and paper-based credentialing processes to digital services is an essential way to help increase transparency and gain patient trust.
CodeMax can help companies automate the process of medical credentialing to ensure they meet industry standards. Our trained professionals can custom design web services that increase access and exceed benchmarks for improving the quality of care while reducing overall costs.
Contact CodeMax for Assistance with Medical Credentialing
Providers will often admit that medical credentialing is a task they do not look forward to undertaking. While it seems like there are only a few simple steps to complete, health providers often describe the process of medical credentialing as a burden. Having the process run smoothly requires meticulous attention to detail and expertise in the field. This is why many providers find they are submitting and resubmitting applications, navigating the headaches of enrollment rejections, and wasting valuable time explaining minor details with insurance companies.
By outsourcing credentialing verification to CodeMax, we take away the burden of maintaining data collection, verification, and reporting, so that you can focus on your patients and are able to feel at ease knowing you are meeting compliance requirements for verification. Reach out to CodeMax today at 866.471.3267. A trained staffer is waiting to discuss how we can help you manage medical credentialing and other essential services.