Physician Credentialing Service
Physician credentialing is the process of verifying and recognizing that a physician is qualified to practice medicine. Credentialing is done by an organization and may occur many times over a physician's career. Credentialing protects the organization by ensuring that a physician working for them, or with them, is qualified for the position. Credentialing also helps the physicians by allowing them privileges in their organizations if they have done good work in the past.
Education and Training
Credentialing includes verifying medial school education and any residency work that the physician did after medical school. Grades are examined as well as references from instructors and colleagues. The organization the physician is applying to work with determines the standards for these records.
License and Certification
Examining the physician's state board license and certification is another aspect of credentialing. All paperwork must be in order for the physician to receive privileges at their organization. Becoming licensed requires credentialing by the state medical board, which will ultimately award the physician licensure.
The experience the physician has had with patients is also evaluated during the credentialing process. This includes the following areas: bedside manner, scope of practice, patient care and experience with various clinical practices. This determines the areas of clinical work the physician will be privileged to work in a particular organization.
Malpractice and Negative Clinical Occurrences
The credentialing process includes reviews of any past events in the physician's practice that led to negative or clinical occurrences malpractice suits. This may include harm to patients, harm to colleagues or legal issues during practice. It is the judgment of the credentialing body to determine whether the physician has had too many incidents of this type to justify providing him/her with privileges.
The physician's character is evaluated through observation in addition to recommendations from past employers and colleagues. Physicians are expected to work under the American Medical Association's code of ethics, which specifies behavior and practice that leads to good character. Protecting patients from harm is very important in physician character.
☎ PHONE & FAX
Toll-free: (877) 428-6606
Fax: (877) 428-6625
PO Box 242621
Little Rock, AR 72223
➤ OFFICE HOURS
Mon-Fri: 7:00am - 5:00pm
Saturday: 9:00am - Noon
We Can Help!
With the constant healthcare changes, many carriers have made it mandatory that all providers - either individuals or groups - get linked as network physician or groups. This also brings in benefit for the physician or physician groups for better reimbursement.
We as a Medical Billing company offer Physician Credentialing Services as a specialty, so that your practice can get benefited by enrolling as in-network/participating providers. This service is for both government and non-government carriers.
What We Can Do
➤ Submit a Letter of Interest to the Managed Care Carrier.
➤ Handle your complete contract requirements, including the provider demographic updating of the carrier files to keep your data up to date.
➤ Follow up on your applications to ensure that it reaches the carrier and is in process. Any queries raised by the insurance carrier are addressed in a timely manner to avoid delays.
➤ Once the carrier confirms the contracting details, we can handle your EDI/EFT/ERA enrollments as necessary.
➤ Deal directly with your clearinghouse to get the electronic remits delivered at your door step (in your practice management system).