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Strategies for Provider Credentialing Success


Medical service providers who wish to get proper reimbursement toward services provided to patients have to undergo the process of provider credentialing. Failure to accomplish successful credentialing may lead to delayed or denied reimbursement.

Significance of Provider Credentialing

An ongoing, complex, and critically important process, credentialing encompasses obtaining physician and facility privileges and successfully enrolling as participant in health plans. The importance of medical credentialing is being recognized in the modern medical industry. One reason is due to the fact that patients place their trust in health care providers with credentialing process performed successfully.

Credentialing is indicative of process improvement and increased efficiency. It assures patients about their health care provider’s experience, qualification, and merits. Modern electronic credentialing process offers medical organizations efficiency, thus positively impacting care quality while reducing burden on all stakeholders.

Advantages of Outsourcing Provider Credentialing

Involving myriad documents that need to be handled and sent to different third parties and careful follow up, credentialing requires more than submitting data. Annual updates and follow up are mandatory, requiring health care facilities and physicians to take active and timely participation in the various formalities. It is better to outsource this time-consuming process for saving a lot of time and efforts.

Similar to several systems that are used for establishing contracts between health plans and care providers, credentialing is also riddled with redundancy. It becomes necessary for different organizations to collect virtually identical data. This makes it advisable for busy providers and practices to delegate their credentialing process to efficient and professional service providers.

Steps to Ensure Credentialing Success

  • Plan and start early
    • There’s no such thing as a swift credentialing process. It requires months of planning. More so, when new physicians join a practice. Payers need weeks for processing credentialing paperwork; it is necessary to plan ahead and prepare the documents that need to be submitted
  • Identifying key success factors
    • Completing a universally accepted and most widely followed credentialing database such as CAQH without leaving any boxes blank is essential.
  • Developing a sustainable process
    • Submission of credentialing forms itself is tiresome task. But it is necessary to keep a work flow that is capable of maintaining all necessary documentation and forms as re-credentialing is always a possibility.
  • Determining the interim steps is important
    • Getting prepared to meet what the payer will require is the wisest course of action

Why Rapid Care?

Rapid Care Transcription Pvt Ltd has been offering reliable and efficient revenue cycle management services to health care facilities across the world. We have professionals who specialize in getting your credentialing process conducted in effective and perfect way.

If you are looking for attracting patients, you need to get fully credentialed and enrolled by health plans. To obtain admitting privileges and have your practice running smoothly, prioritize the vital credentialing process. Visit our website www.rapidcare.net for more details to avail our provider credentialing services.

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