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Five Ways to Smooth Your Physician Credentialing Process

Physician credentialing clearly has its benefits.

Physician credentialing is the process of organizing and verifying a doctor’s professional records. The most important is that ultimately it promotes better patient care by providing standards for medical providers. Credentialing is indispensable, but the process often seems to be more trouble than it’s worth. It can be time-consuming for physicians and their medical practice. It is an industry expectation to verify the professional work history, licenses, education, and background. Worse, if the process is not complete when a new physician joins your practice, cash-flow problems and scheduling catastrophes can happen.

It is possible to reduce the number and severity of delays and other nuisances that come with credentialing. Consider the five steps below which are effective and easy to implement.

1. Do not delay.

In theory, the typical credentialing process generally takes 90 days in most cases. In reality, it is best to give yourself a cushion. Begin the credentialing process at least 150 days before you need your new physician to start. You may not need the 60 days of extra time, but it may come in handy. From the moment you submit your application, you are in the hands of the practice responsible for credentialing. That means that you are on their timeline.

2. Proofread your application.

Forgetting to fill out all of the required fields is a preventable mistake and one that delays processing. Still, about five out of six applications are incomplete or have outdated information. The following four fields are most likely to contain missing or incorrect information.

  • The physician’s work history and current employment, with the scheduled date of starting work at your practice listed.
  • Information about malpractice insurance, such as type and amount.
  • Which colleagues can cover for the physician.
  • Verification of authenticity by qualified witnesses.

Taking a few extra minutes to double-check the application before submitting it can save weeks of backtracking incorrect information.

3. Keep up with the standards.

The Coalition for Affordable Quality Healthcare (CAQH) runs a uniform credentialing program. Adopting the CAQH program helps you stay in line with current credentialing requirements and can make the entire process more efficient.

4. Place contingencies.

When offering a candidate a position, include a clause in the contract that ties the start date to the date of submitting the required paperwork for credentialing. For example, you could stipulate that the physician may not start until 90 or 120 days after submitting a complete set of credentialing paperwork. New physicians may not like the idea, but they will be more motivated to submit their paperwork and are far more likely to do it sooner.

5. Check your state’s requirements.

Your state is likely to have laws that require physician credentialing to begin in a timely fashion. Knowing these requirements gives you clout when encouraging a new physician to submit paperwork. Also check whether the state has reciprocity regulations. If so, a physician credentialed in another state may be able to go through the process more quickly in your state. You can get more information from your state Medical Group Management Association.

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