Exploring Medical Credentialing Solutions

by | Sep 6, 2022 | Blog | 0 comments

Medical credentialing is the process that health care providers go through when they’re starting a practice or joining an existing practice. Doctors, nurse practitioners, physician assistants, and dentists (to name just a few) need to be credentialed by each insurance company they bill their services with. It’s a detailed process that can take weeks or even months to complete.
Credentialing is a necessary part of being a provider. It’s how insurance companies ensure that they’re only paying for services that are medically necessary and appropriate.

Credentialing 101

Credentialing is a process that ensures that medical providers are qualified to be a part of an insurance provider network, giving them the ability to be paid for their work. It also helps protect patients by ensuring that only qualified doctors can practice medicine. Everyone who practices medicine and wants to be paid in any way other than cash must be credentialed. This includes doctors, nurses, midwives, and physician assistants. The process of credentialing varies from state to state but generally involves a lengthy application process wich each and eyery payer.

The payers will review documentation such as transcripts, licenses, degrees, and legal filings to ensure the applicant is suitable. They may also ask about any past disciplinary actions against a doctor and how he or she intends to prevent further incidents from occurring in the future.

A Time-Consuming Process

Given its importance, it makes sense that credentialing is not an immediate process. For medical practices in need of new personnel, however, the wait can be excruciating. The doctor’s credentials may take weeks or even months to be approved. This can cause a delay in opening up their practice and providing care for patients. For some practices, this is the difference between staying open or having to close down due to a lack of doctors.

Slow medical provider credentialing can have a cascading effect across the entire practice. The longer it takes to get new physicians on board, the more patients will be forced to wait for care. This creates an even bigger backlog of patients who are unable to see their primary care doctors on time. Eventually, this could lead them to seek care at another practice that can provide faster service.

Unfortunately, the medical credentialing process can be very complex. It often involves both state and federal regulations that must be followed in order to ensure the safety of both patients and staff. However, there are many ways that practices can streamline this process so as not to hinder their ability to provide quality care in a timely manner.

In-house Medical Credentialing

Medical practices sometimes look to do their own doctor credentialing in hopes of cutting costs and streamlining the process. However, this can be a dangerous decision, as medical practices are not necessarily equipped to handle these tasks. It is best to leave it up to an experienced credentialing agency that has experience in this area and understands the regulatory requirements that must be followed in order to avoid unnecessary down time. It’s also just one more thing to have to remember to do.

Getting Help With Credentialing

Outside agencies that already have the digital infrastructure in place to handle medical credentialing are a great option for medical practices that are looking to cut costs. These companies have the experience and resources to make sure that all of your needs are met in a timely manner, which can help alleviate some of the stress associated with this process.
Furthermore, these companies are very familiar with the requirements of medical credentialing and can help a practice to stay in compliance.

More Efficient Medical Credentialing

TRIARQ, for example, is a company that has a robust infrastructure in place for aiding practices with their medical credentialing solutions. They have an experienced team that focuses exclusively on credentialing every day of the year.

This team makes it easy for practices to outsource the responsibility, headache, and hassle. Furthermore, TRIARQ provides a streamlined process for getting a new practice up and running, as well as providing additional services such as payment processing.

Needless to say, there are many benefits to this.

Save Time

Practices can save time by avoiding the hassle of managing the credentialing process themselves. By using an external partner, physicians and practice managers get all that time back. TRIARQ’s expertise also minimizes downtime by avoiding mistakes and following best practices. This means healthcare providers can simply focus on providing high-quality care and making sure that each patient receives the right treatment plan for them.

Stay Punctual

Medical practices have a lot on their plate. Staying up-to-date with the credentialing process is a lot of work, and it’s easy to fall behind schedule. By working with a company like TRIARQ, medical practices can avoid falling behind on this important task and stay ahead of the competition when it comes to getting new personnel scheduled and ready to work.

Avoid Lost Claims

Lost claims are a great source of trouble in the credentialing process. If a provider’s credentials expire, it can take months to be able to bill it, if ever. In the meantime, the medical practice is still paying the provider’s salary, with no revenue coming in to pay for it. By partnering with a credentialing company like TRIARQ, medical practices can avoid this problem altogether by making sure that every provider is always credentialed.

Medical Credentialing Doesn’t Have to Be Difficult

While the process of getting credentialed may seem tedious and overwhelming, it’s an important step in ensuring that patients get the quality care they need. If a health care provider wants to help their patients, this is an unavoidable responsibility. It serves as a sort of quality control for insurance companies—something that everyone in the industry can benefit from.

Thankfully, medical practices can smooth over the difficulties by teaming up with an electronic medical record (EMR) software company. TRIARQ’s electronic medical records solution is designed to help providers streamline their operations and reduce costs. Talk to one of our business representatives to receive some assistance with credentialing.