What is Medical Credentialing: How It Works?

Date:January 28, 2021 By:Admin

What is Medical Credentialing: How It Works?

Medical credentialing is about checking details of qualification, career history, training, residency, education, license and specialty related certificate of a health service provider. Credentialing is crucial to check before hiring a medical professional as the information is critical to know. Depending on the expertise of the personnel in the field, patients can expect suitable guidance.

What are the criteria to check for suitable medical credentialing?

The credentialing ideas before hiring physician are enumerated as below:

  • Identification proof - One should produce suitable identification proof with photo ID; details of NPI number, employment verification card and others
  • Details of education and training - Details of course completion, internship details, medical school documents, residency, fellowship documents, clinical degrees and others to be furnished when applying in any hospital. One should explain the time gap, if any, along with other suitable certification.
  • Professional license - The candidate should furnish appropriate professional licensure and state the type, status, number, issue, and expiring date.
  • Board certification - One needs to furnish board certification along with original certification and the proof of date expiration for suitable scrutiny by higher authority
  • Criminal background check - The health provider should furnish suitable criminal background proof from the federal state along with the details included in county databases.
  • Checking health status - It is important to check whether the medical service provider has any mental or physical illness record.

The medical credentialing requires this thorough check-up process to ensure the background of the health providers. In addition to the above said, it is important to introduce professional reference with current details of work.

What are the benefits of having medical credentialing?

A health service provider with medical credentialing is an assurance of better service. This would benefit both the patient party and the medical center, hiring the personnel. It is an important assurance for the hospitals who are hiring medical professionals. The medical credentialing services should adhere to the latest insurance and licensing and companies and maintain it. The companies offering them credentialing service should check whether the professional has the required competence to serve the medical industry.

Here, the practitioners benefit from credentialing as the companies' benefits are what the companies look for when hiring professionals. In this way, the patients are benefitted the most when they get service from a competent medical service provider.

For this, it is important to choose reliable sources of medical credentialing services that would help complete the process with ease and the required expertise.

Who should have medical credentials?

The credentials are important for different healthcare service providers and the list is enumerated as below:

  • Physicians
  • Psychologists
  • Podiatrists
  • Marriage and family therapists
  • Optometrists
  • Physician assistants
  • Social workers
  • Chiropractors
  • Counselors

Therefore, the system of credentialing is comprehensive and includes the time taking process to be followed. It is mainly done to cover up aspects related to the healthcare industry and adhere to the industry standards while delivering service.

Which type of facilities needs credentialing?

Other than practitioners, it is some type of facilities that need to maintain standards of competence and have credentials. The lists of facilities that need the credentials are listed below:

  • Dialysis
  • Home health service
  • Hospice Care
  • Ambulance care
  • Durable medical equipment
  • Medical care service at home
  • Prosthetics or orthotics
  • Sleep studying clinics
  • IV Home infusion therapy

Having credentialing service is an added security and assurance of service both for clinics and patients availing the service.

Process of medical credentialing

The credentialing comprises some processes like giving credentials, enrolment and availing of privileging.

  • Credentialing - In this, it is about verifying the skills, knowledge of training program, checking license and qualification of the individual and justifying their eligibility
  • Enrolment - It is mainly about ensuring the provider with suitable insurance results
  • Privileging - The service providers of credentials should give licensing to perform some process and also grant some benefits to the medical personnel

Is work allowed to serve during the credentialing period?

No, the healthcare provider needs to wait till the procedure is completed. Only after it has been approved can the personnel start working based on its assurance in the medical field. This assurance is important to both healthcare centers and patients who approach the medical personnel. When centers or patients approach non-credentialed personnel, it is kind of raising the quality of medical assistance. Any person or medical student requires credentialing when they want to offer service outside their study program or training. If they are yet to complete the training part, they may not be eligible to be part of the credentialing process.

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