Physician credentialing is a critical part of modern healthcare and plays an essential role in maintaining the quality and integrity of healthcare delivery.
Although credentialing is one of the first steps toward practicing, it’s an ongoing process required throughout a physician’s career. The primary goal is to ensure a physician remains qualified and continues to possess the competencies to safely practice medicine and provide quality patient care.
There are distinct steps while going through the process:
Credentialing.
According to the National Library of Medicine, credentialing means qualifying and verifying a physician’s medical credentials using established guidelines that ensure patients receive the highest level of care from healthcare professionals.
Privileging.
Also referred to as “hospital privileging,” which gives physicians the authority to work at a specific facility, performing services based on their credentials verified in step 1.
Enrollment.
This step involves enrolling the physician with insurance carriers so they can bill and be reimbursed for their services rendered. This step requires completed credentialing and privileging.
The process varies by state and can be time-consuming.
Some facilities and insurance companies finish credentialing and enrollment within a few weeks, while others may take up to several months. You can’t necessarily speed up approvals or shorten the application, but you can do a few things to simplify the process;
Familiarize yourself with the requirements of the state where the physician will be practicing.
Store current and up-to-date copies, both digital and print, of all the documents required for credentialing.
Check-in periodically to check on the status or if anything additional is needed.
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