Provider Credentialing in Washington State

Provider Credentialing in Washington State

Provider credentialing is the process of verifying the qualifications, education, and training of healthcare providers, including physicians, nurses, and other allied health professionals, to ensure they meet the standards set forth by insurance companies. The goal of credentialing is to ensure that healthcare providers are competent and qualified to provide safe and effective care to patients.

Provider credentialing is important because it ensures that healthcare providers meet the standards set forth by state licensing boards, and insurance companies. This ensures that patients receive high-quality care from qualified providers. It also protects healthcare providers from legal and financial risks associated with hiring unqualified providers and helps insurance companies determine which providers are authorized to participate in their network and receive reimbursement for their services.

Provider Credentialing in Washington State

In Washington State, healthcare providers are required to undergo a credentialing process before they can provide services to patients. The process typically involves the following steps:

  • Application: Healthcare providers must complete an application and provide documentation of their qualifications, education, and training. This includes their medical degree, licensure, and certification.
  • Primary source verification: Insurance companies must verify the information provided by healthcare providers through primary sources, such as state licensing boards, educational institutions, and professional organizations.
  • Background check: Insurance companies conduct a background check to ensure that healthcare providers have not been convicted of any crimes or had any disciplinary actions taken against them.
  • Credentialing committee review: Insurance companies have a credentialing committee that reviews the provider’s application, primary source verification, and background check results to determine whether the provider meets the insurance company’s standards and requirements.
  • Notification of decision: Insurance companies will notify healthcare providers of the credentialing decision within a reasonable time frame.
  • Re-credentialing: Healthcare providers must undergo re-credentialing every two years to ensure that they maintain their qualifications and meet the Insurance company’s standards and requirements.

Unique Facts about Provider Credentialing in Washington State

When you are planning to get credentialed in Washington State, you must be familiar with couple of key facts. First is DOH provider credentialing search while second is OneHealthPort. Let’s explore them in detail:

1. DOH Provider Credentialing Search

The Department of Health (DOH) provider credentialing search is a tool that allows patients to search for healthcare providers who are licensed and credentialed in the state of Washington. This search tool is designed to help patients make informed decisions when choosing a healthcare provider by providing them with information about a provider’s credentials, license status, and disciplinary history.

The DOH provider credentialing search is available on the DOH website and can be accessed by entering a healthcare provider’s name, license number, or other identifying information. The search results will display information about the provider’s license status, license type, expiration date, disciplinary history, and any other relevant information.

The DOH provider credentialing search can be particularly useful for patients who are looking for a new healthcare provider or who want to verify that their current provider is licensed and credentialed. Patients can use the search tool to ensure that their healthcare provider is in good standing with the DOH and has not had any disciplinary actions taken against them. The DOH provider credentialing search may not include information about healthcare providers who are not licensed or credentialed in the state of Washington.

2. OneHealthPort

OneHealthPort is a web-based platform that provides a secure and efficient way for healthcare providers in Washington State to manage their administrative tasks, such as credentialing, claims submission, and communication with other providers. OneHealthPort was established in 2001 by the Washington State Legislature to improve the efficiency and quality of healthcare delivery in the state.

Healthcare providers who wish to use OneHealthPort’s services for provider credentialing in Washington State must open an account with OneHealthPort. An account is necessary to access OneHealthPort’s tools and services, such as the Provider Data Management (PDM) tool, the Universal Credentialing DataSource (UCD), and the Provider Credentialing Application (PCA) tool. By opening an account, healthcare providers can manage their credentialing information and submit applications to multiple healthcare organizations at once, which can save time and effort in the credentialing process. Opening an account with OneHealthPort is a simple process, and can be done by visiting their website and following the registration process.

OneHealthPort provides several tools that are useful for healthcare providers in Washington State during the provider credentialing process. These tools can help streamline the process and make it more efficient, allowing providers to focus on patient care.

Provider Data Management (PDM): PDM is a tool offered by OneHealthPort that allows providers to manage their demographic information, credentials, and other important information in a single, secure location. PDM can help providers easily provide their information to credentialing organizations, reducing the need for manual paperwork and data entry.

Universal Credentialing DataSource (UCD): UCD is a service offered by OneHealthPort that allows healthcare organizations to share credentialing information with each other. By using UCD, providers can apply to multiple organizations at once, reducing the need to submit multiple applications and duplicate documentation.

Provider Credentialing Application (PCA): PCA is a tool offered by OneHealthPort that allows providers to complete and submit credentialing applications online. This can reduce the time and effort required to complete credentialing applications, and can also reduce the chance of errors and omissions in the application.

Credentialing Verification Organization (CVO): OneHealthPort’s CVO service can help healthcare organizations verify the credentials of healthcare providers. CVOs can save time and resources by verifying credentials for multiple providers at once, and can also help ensure that healthcare providers meet all necessary requirements.

To Conclude,

In Washington State, healthcare providers must undergo a credentialing process that involves verifying their qualifications, education, and training, conducting a background check, and undergoing a credentialing committee review. Healthcare providers must also undergo re-credentialing every two years to maintain their qualifications. Understanding the credentialing process and the key factors that healthcare providers need to know can help ensure that they meet the requirements and provide high-quality care to patients.

We hope that this article has given you insights on provider credentialing in Washington State. You are advised to connect with insurance companies for exact provider credentialing requirements. In case of any assistance required, you can check our provider credentialing and enrollment services. Legion Healthcare Solutions is a leading medical billing company providing complete billing and coding services. We can assist you in complete provider credentialing and enrollment process for various payers including Medicare, Medicaid, and major commercial payers in your area. To know more about our provider credentialing and enrollment services, contact us at 727-475-1834 or email us at