The Beginner’s Guide to Doctors

Physician Credentialing and Network Enrollment

The process of verification of educational, training and skills that are possessed by a health practitioner is referred to as healthcare credentialing. It involves varies procedures. Some of these tasks include verification of the covered medical college, confirmation that studies were completed and verify on further training such as internship, residency and fellowship. It involves going back to the primary source of these credentials. For license verification, the state licenses board will have to be contacted. It would involve whether the license is active and whether any limitations apply for the license. The medical school would have to be contacted to verify that a medical degree was received by the concerned party. Depending on the complexity of the process and items that have to be verified, the process can be long.

The roll of the practice credentialing s to allow medics participate in insurance plans and for health institutions to allow practitioners to offer services in their satellite campuses.
Getting Creative With Providers Advice

The provider enrollment is process of application by a service provider to participate in a health insurance network. The procedure starts by application to participate in a network/plan, submitting documents for credentialing process, other documents submission, submitting a license to a carrier and signing a contract. There might be other document requirement and processes for various carriers. There is high trust among carriers on CAQH as central store for health information. For enrollment process, every physician should have an up to date profile in the CAQH system. The health plans use the credentialing process to confirm education, training, licensing and other specific requirements needed to participate in a health plan. After the credentialing process has been through, the network offers a participating contract.
If You Think You Get Enrollments, Then Read This

The payor influences the processing time for enrollment. While some plans can be completed within 90 days; others will take up to 180 days. After submitting documents for enrollment, the provider should do a follow-up. This can be done using certified mail, emails, fax, documenting phone conversations with agents and others.

There are some companies that help service providers with physician enrollment procedure to make it easy. One is only required to pay some fees for these tasks. They do the paperwork and follow up on the insurance carriers on behalf on their client. The benefits of working with these firms are that they save the physician on time. The physician also stands to befit from their daily experience working with the insurance firms. Physician credentialing and provider enrollment should not be a nightmare for a service provider after updating their profile with CAQH system and working with facilitating companies. This will only work if the physician have a clean record.