Legion Healthcare Solutions

Physician Credentialing

In order to maintain the quality of care, regulators have implemented physician credentialing. In physician credentialing, regulators verify several aspects about the physician that includes admitting privileges, education, insurance, professional references, work history, board certificates, and many other aspects. For physicians, the challenge is maintaining the up to date information on its experience, references or certificates; hence outsource physician credentialing teams become vital to the process.

The affordable care act 2010 has substantially increased the requirements of physician credentialing. The demand for compliance by regulators is to reduce fraud and abuse, currently, most of the physician credentialing is required by payers, federal government and accreditation agencies. Individual credentialing is required for each payer, and each of the payers has their own internal timeline for credentialing.

For any physician today, it’s important that they start credentialing process as early as possible that takes anywhere between 90 to 180 days. Outsource Physician credentialing teams can keep speedup your credentialing process by keep the information up-to-date periodically and analyze the missing information affecting your pay.

Most payers have a uniform credentialing program, The Coalition for Affordable Quality Healthcare (CAQH).  Hospital credentialing can no longer be used for physicians credentialing it was possible earlier.

Here are how Legion Physician Credentialing differs:

Reason 1
State and Federal Regulations

Many states across USA have their own laws to bring timely credentialing. Some of the laws assist physicians if they are already credentialed in a different state they can streamline the process, few states have even made changes to rules to help out those who move from one practice to another don’t have to go through complete credentialing.

Reason 2
Begin Early

Most payers do physicians credentialing within 90 to 180 days, so it’s always better for a physician to start the process early to reduce delays. Most small payers have merged and become supersized; hence it’s important that physicians understand the timeline, and each payer has its own timeline for credentialing.

Reason 3
Information Updates

It’s estimated by a payer that around 85 percent of applications that come for credentialing have missing critical information. Such missing and incomplete information leads to further delays in an already slow process. Here are some areas missing information are most common:

  • Work history and present work profile.
  • Hospital privileges if applicable and covering colleagues.
  • Attestations from various medical agencies.
  • Most credentialing delays, according to payers, can be avoided if a dedicated team looks into the process.
Reason 4
Updating with CAQH

Coalition for Affordable Quality Healthcare (CAQH) started the credentialing process about 15 years ago, since then most payers have shifted to the program to keep uniformity. Physicians who can regularly update and attest with CAQH will be able to find credentialing and re-credentialing much easier.

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