To most people out there, they may not know what the term medical credentialing means and this is the reason why this guide has been developed to help you understand this. In simple words, this is a process which is normally market driven that aims to maintain the required standards in the medical community in terms of benefiting the patients. It is a process that involves a direct contact with the main sources so as to authenticate and verify the qualifications of the healthcare provider. In the whole medical credentialing process, the CVO, which is the credentialing authority, contacts the university which a healthcare provider graduated from in a degree of medicine, the places or colleges from which they go their trainings and also their residential areas or places as a way of verifying their credentials. To verify the certificates and specialty of the healthcare provider or providers, the CVO also contacts the certification boards and licensing bodies respectively.
It is also to note that medical credentialing is imperative to all new employees. To ensure that you in full compliance with the standards set by the regulatory bodies which include NCQA, TJC, and CMS, you have to make sure the medical credentialing process is carried out regularly to your employees even after hiring them. It is also good to note that the full process of medical credentialing has two parts which are credentialing as well as privileging. The privileging part means that the healthcare provider is granted an approval to perform specific procedures as per the skills and competencies which he or she could have demonstrated. The credentialing part is where the competency of the healthcare provider is verified as per education, licensing, training as well as the healthcare provider work experience.
After reading the above highlights and knowing clearly what medical credentialing entails, it is also good to understand its various benefits or why it is an imperative process. One, it is a professional way of making sure that the medical industry has quality assurance where all parties involves are beneficiaries. Through this process, the healthcare facilities will be confident that they have healthcare professionals who are skilled enough to offer high quality medical services. Besides, the insurers will also will also cut o the overall cost because medical services will be offered by very skilled and experienced medical practitioners. When it comes to the medical practitioners, medical credentialing gives them an upper hand to receive clients from various insurance firms and this makes it easy for them to increase patients number..