10 Things to Know about Provider Credentialing

For many of us, provider credentialing might seem to be like a paper work. But, it’s something more than that! Provider credentialing is increasingly essential to allow patients to confidently keep faith and trust in their healthcare professionals. With a standardized process that includes data collection, essential source confirmation and panel audit by healthcare organizations, patients will be guaranteed about their healthcare professional’s merit and experience, which is very crucial.

In the present digital scenario, many innovative technologies are ruling the healthcare and medical billing industry. Credentialing is one of the key areas for increased productivity and process improvement. Here comes 10 important things to know and learn about provider credentialing.

Purpose of Provider Credentialing:

  • Provider credentialing is basically a process of verifying and assessing healthcare professional’s education qualifications, work history, training and experience, residency and licenses specialty certificates and other qualification details.
  • The most important thing to know is, which is the right time for credentialing?
  • It’s very much better to consider credentialing while hiring a healthcare provider and basic thing is to check and verify if the information stays up to date.

    1. Provider Credentialing builds patient’s trust:

  • While discussing about healthcare system, trust is very significant and essential. Trust between patient and healthcare professionals engage for a better patient care delivery.
  • If a patient doesn’t know about the healthcare professional, or qualifications and specialty, the patient will have complete trust on healthcare professional to share his/her health information.
  • By assessing as well as verifying the healthcare provider’s qualifications and experience, Patients will confidently trust their chosen healthcare providers.

    2. How do Provider Credentialing prevent loss?

  • For healthcare professionals and hospitals, it’s necessary to partner with insurance companies. They need to produce a list of verifications to insurance companies if they decide to be considered for reimbursement expenses.
  • If healthcare professionals fail to obtain proper credentialing, it will result in losing reimbursements from insurance companies.
  • Medical billing companies allow professionals to perform services prior to credentialing and insurance companies backdate the reimbursements to cover the services.
  • Just because the time limit is considered, healthcare professionals might lose thousands of dollars that won’t be covered by insurance companies.

    3. Does Provider Credentialing reduce the risk of errors?

  • As estimation, every year, about 98,000 Americans lose their lives due to medical errors.
  • The statistics are really worrisome; it compels healthcare industry authorities and leaders to campaign for improved standards of competency and exposure to disciplinary actions against healthcare workers.
  • Credentialing healthcare professionals including independent practitioners will help reduce the risk of potential errors caused by incompetent healthcare professionals.
  • However, since electronic credentialing depends on automation tools, there’s no place for human errors or fatigue associated with manual evaluation processes.

    4. Credentialing helps hospitals in hiring:

  • During provider credentialing process, healthcare professionals must go through an in depth examination process that includes evaluating their educational background, work experience, residential history, and license.
  • The process is most likely performed during the time of hiring a healthcare professional and verifies if they are qualified to perform the works mentioned in the job description.
  • It’s also very essential to check the credentials of healthcare professionals to help them remember their network.

    5. Improves Healthcare Professional’s Business:

  • Provider credentialing allows healthcare practitioners to accept patients who possess healthcare insurance.
  • At present, majority of Americans hold on to healthcare insurance plans. It’s a benefit added to healthcare professional as it increases clientele.
  • It’s also evident that most of the patients prefer meeting the same healthcare professionals again and again.
  • Provider credentialing therefore, will result in recurring patients which, in turn, enhances the practitioner’s business.

6. Enhances Healthcare Professional’s Reputation:

  • For most of the patients, now doing a research on their healthcare professionals before committing them has become vital.
  • Healthcare professionals can actually manage and retain their clients or patients by controlling their online reputations.
  • One of the key important steps is to take care of or to improve in order to concentrate on their reputation through provider credentialing.
  • A healthcare professional who has undergone the above process is allowed to treat patients with permission and license regardless of their insurance plans.
  • As the healthcare professionals are capable of handling diverse range of patients, they will most likely earn reputation from every corner of the world.

    7. Protects Hospitals with Potential Lawsuits:

  • In several states, the existed law or rule requires provider credentials to go on legal documents like medical documents and prescription.
  • These laws also cover professional activities including legal testimony, speaking engagements, also research publications.
  • Without any proper provider credentialing, the hospitals might miss the most important things required by the law.
  • Provider Credentialing also requires to ensure that whether healthcare organization or hospitals adhere with the letter by the law. This process allows healthcare organizations to perform data queries which allow having a look at the malpractices and claiming history of providers.

    8. Provider Credentialing, a cost saving approach:

  • Healthcare organizations are under increasing pressure to lower the cost of operation and simultaneously streamline hospital processes.
  • Electronic credentialing paves a way by allowing these facilities to migrate from paper system to cloud based solution.
  • It lowers the cost without affecting the health and safety of patients.

    9. Increased Third-party Reimbursements:

  • One of the most over looked benefits of credentialing is that it eventually authorizes payment claims from numerous insurance companies.
  • It has the ability to perform services to patients with multiple types of insurance coverage and reimbursements.
  • It means that the process of affiliating with an insurance company is essential so that healthcare professional can accept third party reimbursements.

    10. It Provides Competitive Advantage:

  • Patients are more advanced and knowledgeable as well as look into various aspects before choosing a healthcare professional.
  • Patients always choose a healthcare provider who is experienced in providing specialty treatment.
  • Provider credentialing also enlists the qualifications and previous experiences of healthcare professionals which can showcase them as market material.


These are the 10 things to know about provider credentialing. To know more, subscribe to our blog. Follow us on Facebook, Twitter, Instagram and LinkedIn for more updates on healthcare.

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