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Significance of Credentialing


Establishing the capabilities and qualifications of licensed medical professionals and evaluating their legitimacy and background is essential – health care practitioners who wish to operate as in-network providers need to undergo this vital process.

The Fundamentals of Credentialing

Considered one of the critical components of the health care services, credentialing has been in vogue since centuries. With the process having undergone continuous evolution, its core content remains unchanged: verification of education, experience, training, skill, and willingness to serve by the provider.

Guidelines and working method have been set on the process of credentialing by the National Committee for Quality Assurance (NCQA). These ensure that providers undergo strict verification regarding their competence and ability so that patients will be receiving the highest level of health care.

The Process of Credentialing

The insurance company verifies the medical professional’s education and competence. Each provider has to first submit a credentialing application which describes their qualifications and training for treating patients in their specific area of specialty.

Why is Credentialing Considered Important?

The process of evaluation of practice history and qualifications of medical professionals boosts the confidence of patients and assures the providers that their colleagues are bound by the same standards. Credentialing shows that health care facilities value quality care. It confirms that they place patients’ well-being as one of the primary goals.

Health insurance and revenue cycles playing significant roles in today’s health care environment, failure to perform proper credentialing will lead to denied or delayed reimbursements toward services provided. Moreover, it may result in serious consequences associated with legal compliance and lead to monetary losses and even criminal charges.

Provider credentialing, having been overlooked as a vital component of health care management facilities for years, has been recognized as important presently because of its impact on compliance needs.

Exclusive Credentialing Services by Rapid Care

The process of getting affiliated with an insurance company is essential for medical service providers in order to accept third-party reimbursement. While it is crucial for practice success, getting credentialed on the insurance panels proves difficult for practices. It distracts them from providing optimal care to patients. Long enrollment applications and a lot of time required for follow-up render the process unwelcome by busy practices. Here’s where Rapid Care comes to the aid of health care facilities by offering medical credentialing solutions.

Our credentialing services remove the hassle out of getting in-network with your chosen insurance companies. You can get more details on our effective credentialing services by visiting our website www.rapidcare.net

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