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Credentialing is the process of verifying and establishing the qualifications of licensed healthcare professionals before they can start billing insurance companies for their services.
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It is necessary to establish the legitimacy of a physician’s background and determine the facts before they become part of a provider network – a hospital or facility.
The system demands it, and that is how it works.
Ordinarily, insurance credentialing, medical credentialing, and physician enrollment terms are used interchangeably but have the same meaning.
As a physician credentialing service, Innovit does everything in its professional capacity to verify, assess, and determine the legitimacy of healthcare professionals. As it takes time, we expedite the process through timely follow-ups and dedicated mindset.
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Why is Credentialing Important?
It is a legal obligation on healthcare organizations and facilities to verify the qualifications of an MD. By verification of the provider’s identity, academics, work experience, malpractices, sanctions, and license authenticity, it is a means to keep providing patients with quality healthcare services.
Credentialing As a Process
Here we explain the steps involved in provider credentialing process flow. Once we understand them, Innovit declares where and how it comes in to assist providers against the task. It can take 2 to 4 months to complete it, depending on a variety of factors.
Let’s take a look at how it happens.
1- A physician asks to join a provider network2- Credentialing teams/specialists take charge of the process3- Submission of credentialing application4- Audit the application for accuracy and data integrity5- File the application6- Insurance company decides if the provider meets its internal qualifications7- Credentialing file is approved or disapproved8- Payer issues a participating provider contract in case of approval9- Provider is ready to bill the insurance carrier and receive reimbursements
Note: Failure to complete the credentialing process results in out-of-network reimbursement for services rendered. It means patients have to pay more out of pocket when visiting an out-of-network provider.
How Does Innovit Simplify the Process of Credentialing?
Innovit Healthcare Solutions is on a mission to support clinicians and hospital networks in ways that the care process remains unflustered. As a result, we foster technology, expertise, and experience to bring about a healthy change for the healthcare community.
We leverage all of our available skills to benefit practitioners who want to get credentialed. Therefore, at step 2, we start to push our limits to excel on their behalf, provider networks, and insurance companies.For fewer hiccups and more seamless breathing, we activate all our resources and leave no stone unturned to get them credentialed.
From step 2 through to step 8 of the above list, Innovit’s health IT analysts keep at it until the provider is ready to bill, be it Medicare, Medicaid, or a private insurance company. Sublime services include the usage of the right tools at the right time to simplify and overcome hurdles along the way.
CAQH ProView comes in the use of many healthcare providers to self-report career-oriented information. Health plans, hospitals, and physician groups may make use of it to hasten the process.
What Do We Need To Get You Credentialed?
We need the following from your side:
• National Provider Identifier (NPI)• Professional licenses• Certificates• Degrees• Diplomas• CV• Work references
Please share with us your documents at firstname.lastname@example.org