Best practices for successful Provider Credentialing

1. Assign a Coordinator to the project

It’s smart business to designate a credentialing coordinator to remain on top of deadlines and expirations, whether you outsource credentialing services or handle them in-house. He or she can send out timely reminders to ensure that no one’s credentialing expires, preventing reimbursements from being disallowed as a result.

2. Prepare For Pleasant Surprises

Give yourself plenty of time to complete the credentialing process.
While accreditation “should” take about 90 days, smart procedures allow for more like 150. Credentialing with payers must take place on their schedule, and each has its own schedule. Assume that certification will take 150 days, and be pleasantly surprised if it takes less time.

3. Plan Ahead

Tie the start date of a new provider to the submission of credentialing forms.
Many offices will ask for credentialing documentation as soon as an offer of employment is made. Others attach the start date of a new physician to the completion of paperwork. For example, you may schedule a new physician’s start date 120 days after receiving his or her certification information.

4. Create a Credentialing Process That Is Long-Lasting

Creating a credentialing workflow is difficult, but it pays off in the long run. Even if you outsource the credentialing process, your workflow should keep track of all essential papers and paperwork. Re-credentialing appears to be a constant in a multi-physician practice, and having a workflow in place to support it is extremely beneficial to the business.

5. Make sure all of your doctor’s contact information is up to date.

Ensure that your office manager or credentialing company has accurate and up-to-date contact information for all of your providers. Dealing with credentialing or re-credentialing issues can take longer than it should if you don’t have direct touch. Multiple paperwork must be submitted as part of the credentialing process, and clear communication is required at all times.

6. Ascertain that all physicians are aware of what is expected of them.

Every provider should be aware of his or her obligations in terms of credentialing and recredentialing. Make it obvious to the new hire as soon as the job offer is made that you require certain information, such as work and education history, certification and license information, and malpractice liability certification, among other things.

7. Early on in the process, conduct your own background check.

Before making an employment offer, many practices prefer to do their own background checks on incoming physicians, including verifying training, licensure, and employment history. It may appear to be overkill, but it can help you avoid employing a physician only to have licensure issues later on.

8. Learn everything there is to know about the laws in your state.

Your state may have its own credentialing legislation, as well as reciprocity agreements with payers and other state credentialing bodies. If a physician gets credentialed with a payer in one state before relocating to your practice, credentialing for the new job may be streamlined.
Understanding how credentialing works can make a big impact in how well a practice functions and how quickly money comes in. Credentialing issues may be costly and time-consuming, so it’s critical to have a procedure and a plan in place to ensure that credentials are constantly up to date.