Physician Credentialing & Provider Enrollment
 
What is Physician Credentialing?

Physician offices, hospitals, managed care insurance institutions as well as laboratories all credential physicians. As a matter of fact, credentialing is actually the act of acquiring information regarding the medical provider or the doctor in order to ensure their qualifications to the practice of medicine in their certain specialty. Learn more about  Provider Enrollment , go here. 

There are a couple of companies that supervise the credentialing methods. The URAC or Utilization Review Accreditation Commission is seen as the leading company that monitors all the qualification and credential standards in the health care. It is important for the medical providers to go through a process of credentialing before they will be employed by medical facilities or insurance companies. The physician credentialing is also called as medical credentialing, this will certify their educational background, training, licensure, quality and the entire ethical standards of the provider in the medical society. Find out for further details on  Payor Enrollment right here.

The credential process of the doctors starts with the medical provider giving information to the credentialing company for a review. Areas of concentration include:
Education - certify medical school as well as PGI training.
Board certification - specialty training and certification
Licenses - where the physician holds licenses
Malpractice claims - check for any awards or malpractice claims
Background check - any history of criminal records
Federation of state of medical board review
Malpractice insurance - making sure suitable degree of insurance available
Privileges - the hospitals where the physician is practicing
Resume detailing work history
Personal references

All of the information that are gathered will then be reviewed by the physician review committee. This committee will make recommendations to the standing and professionalism of the provider in the medical society. The committee usually assess the ethical value of the physician.

The insurance companies including the payers sponsored by the government will take time to research on the credentials of the doctor before they accept him or her in their group of practicing medical providers. The Medicaid and medicare will not let the doctors who have not undergone their credential processes to bill for services. Managed care institutions also have a firm physician credentialing method before the medical provider will be listed in the insurance company. A lot of private doctors practices also require credentials from their doctors in order to make sure that quality care is given to the patients.

In short, the credential process is very important before the doctors are accepted in a certain institution in order to make sure that quality care will be provided to the patients. Take a look at this link  https://en.wikipedia.org/wiki/Credentialing for more information.