For medical residents and other soon-to-be medical professionals, or even medical professions taking on a new position, the physician credentialing process can be a daunting task. Whether you’re a physician or another type of medical provider, such as a nurse practitioner or physician’s assistant, you will need to complete the credentialing process. Let’s explore why credentialing is necessary, what all is involved, and how it happens.
What is Physician Credentialing?
In the United States, medical professionals are required to have completed specific levels of education, passed licensure tests, and completed on-the-job training, such as a medical residency, before they can formally practice medicine, dispense medication, or work professionally as a medical provider. The physician credentialing process is essentially a confirmation that all of these steps have been completed, tests were passed with the appropriate score, and the appropriate training was completed. Credentialing is required by all healthcare employers in order for a medical provider to practice. Additionally, different states have different requirements, so it’s important to verify exactly what is needed for your situation.
Why do Providers Need Doctor Credentialing?
Doctors and other medical providers need official credentials to verify that they are capable, competent, and able to provide patients with the highest quality of care in accordance with the established guidelines. The physician credentialing process is the action of verifying those credentials so that patients can trust and know that they are receiving medical care from a verified professional. Finally, credentialing also ensures that there is a standard of care and that all working in healthcare are capable of providing care in accordance with those standards.
Ultimately, all medical providers are required to undergo credentialing before practicing in their field because it acts as a safeguard for patients, the facilities medical providers work within, and even the medical provider themselves. When a provider is officially credentialed, there is no question whether the care provided is ethically sound, medically appropriate, and safe.
Who Conducts the Physician Credentialing Process?
Medical providers in need of official physician credentialing can obtain their credentials through a variety of services and companies, often including their employer. However, many medical employers will use a physician credentialing service.
Physician credentialing services are often preferred because of the individualized attention, expertise in knowing what documents are needed from where as well as how to get them, and because of all of that, they are often able to provide a faster turnaround on the physician credentialing process.
What are the Steps to Physician Credentialing?
Physicians and those looking to obtain medical credentialing should consider building a checklist of the physician credentialing process because credentialing involves a lot of paperwork, and without each of the pieces, a provider’s qualifications cannot be verified, which means a provider cannot work as a medical provider until that is completed. Additionally, before a medical provider can get to work, they need credentialing, privileging, and enrollment, which are all generally considered part of the physician credentialing process.
Physician Credentialing Process Step 1: Credentialing
The very first step, and perhaps the most labor intensive step in the physician credentialing process is filling out the credentialing application, where all requirements are verified and assessed for completeness. While those early in their education for a healthcare career may think that credentialing would be easy, it is unfortunately a fairly complex and involved process, primarily due to all of the different program requirements involved in healthcare, such as those from medicaid, medicare, and private insurers.
Those seeking credentialing will want to create a curriculum vitae and also assemble all of the supporting documents, including proof of education, including diploma, certificates of completion for things like residency, fellowship, etc., copies of professional licenses, licenses related to medications and the ability to disburse controlled substances, as well as insurance. References and copies of physical and mental wellness exams are also required to ensure the provider is capable of providing medical care.
Once the full physician credentialing process is complete, the provider is able to provide care at a healthcare facility; however, assembling all of these documents is only step one.
Physician Credentialing Process Step 2: Privileging
The second step of the physician credentialing process is privileging. Privileging occurs when a medical provider is granted certain privileges in accordance with that provider’s type of practice. Privileging is specific to the provider, their credentials, and their performance. For example, while all doctors must complete medical school, in order to practice, he or she may pass particular boards that grant them the privilege of practicing a specific type of medical care, such as board certification for a specialty.
Physician Credentialing Process Step 3: Enrollment
Typically the last step in the physician credentialing process, enrollment is what allows medical providers to be paid for their services. This part of the complete credentialing process involves the provider signing up to be in-network with an insurance provider. For most medical providers, enrollment typically involves getting registered with government programs, including Medicaid and Medicare, as well as with private insurances. The insurance registration process is very similar to the initial credentialing process and requires a number of documents, licenses, proof of malpractice insurance, and more.
How Long Does the Physician Credentialing Process Take?
For those needing to obtain physician credentialing, you may be wondering how long the physician credentialing process takes. The bad news is that it can take a few months to become fully credentialed. However, there are ways to cut down on time, like staying organized and having documents ready. Because it takes such a long time to complete the physician credentialing process, it is recommended that residents begin assembling all of the necessary documents before they complete their residency. Physician credentialing services, like those offered by Credence Global Solutions, will help you even if you didn’t get started in advance.
Get Started With the Physician Credential Process Today!
Physician credentialing service providers are an excellent resource for large facilities like medical groups and hospitals, but we also help individuals seeking credentialing. Are you ready to dive in and start the physician credentialing process? Contact us today, and we will help you every step of the way!
