Physician credentialing is a mandatory process to generate revenue. Being Out of Network (OON) can turn out to be complicated and challenging in terms of getting the reimbursement for service rendered. Therefore every physician aims to get credentialed and being In-Network with the top insurance careers to ensure they can get their claims processed effortlessly and stay away from the hassle of OON complications. However, the process of physician credentialing itself can sound painstaking for medical practitioners with the array of documents, paper works to be provided supporting the credentialing application. This article aims to be a quick guide to Physicians looking for Physician Credentialing.
Complexities involved in Physician Credentialing
Physician credentialing is a detailed process of acquiring and validating the complete data related to the physician’s education, medical certifications, work history, career gap to ensure quality patient care as per the standardization. Providing incorrect or insufficient information or missing any mandatory supportive documents along with the application can further complicate and extend the process. Handling Physician credentialing requires deft hands that have been in the process with good experience.
When to Start with Physician Credentialing Process
The Process of Physician credentialing can take anywhere from three months to 6 months. Which signifies the importance of starting early to avoid unexpected delays causing revenue loss. Check out the below points to know when to start or approach the physician credentialing process.
- Beginning with Medical Practice after Medical Graduation
- Looking to get enrolled with new Insurance
- Changing employers or Shifting from current state
- Adding new physicians to facility or Medical Groups
Checklist of Documents Required for Physician Credentialing Process
- Filled Up Credentialing Application duly filled with all mandatory information
- Medical Gradation and Board Certified Certifications
- Internship, Residency and Affiliation details
- State Licensing
- CME completion documents
- Current CV and Recent Photograph
- Work History with details on career gap and reason
- SSN and Driving License copies
- NPI and Tax Id Number
- Malpractice Insurance
- Peer Reference
Guide to Physician Credentialing
While the process of physician credentialing can seem to be detailed and cumbersome, following the below steps can ensure stress-free and timely processing.
- Recognize the importance of Physician Credentialing and start early. Knowing that credentialing and enrolment process might take longer than expected and also can affect revenue flow helps plan efficiently.
- Understand the type of credentialing required to meet your professional setup.
- Updating CAQH and PECOS as required
- Knowledge of State regulations and payer guidelines for Credentialing and Enrollment.
- Approaching a diligent and experience Credentialing Coordinator.
Outsourcing Physician Credentialing
Outsourcing Physician Credentialing process is the best approach to ensure timely enrolment and cost-saving. Having an experienced team of credentialing get on your enrollment process can help fasten and avoid unnecessary delays to missed or insufficient data. Outsourcing to a credentialing partner can mean a smooth and clear process.
About MGSI
MGSI is a National Medical Billing Company located in Tampa, FL that has been providing complete Revenue Cycle Management Solutions for more than 25 years. Our Credentialing team with a strategical approach towards each credentialing process can ensure to get your applications to get accepted at first submission itself. To know more about MGSI call 1-877-896-6474 or log on to www.mgsionline.com