Physician Enrollment & Credentialing To Authenticate Providers

by Fizza Arshad Senior Content Writer

Physician enrollment and credentialing services are highly specific and difficult to execute. This process helps in hiring new doctors, verifying their data, their credentials, ready to earn your trust as a reliable and trustworthy physician or specialty-specific clinician. Some medical billing companies also provide physician enrollment and credentialing services.

Physician enrollment and credentialing remove confusion or ambiguities in the hiring process. This process authenticates those job seeking clinicians and puts their name on the panel of approved doctors. It’s like an official stamp for their hard work as a student going through challenging education stages and becoming a professional. This procedure also gives you and your institution maximum exposure to quality health care, invaluable treatments and gradually moving towards building a long-term reputation as a result. Don’t you want your organization to be the number 1 trusted facility?

Residents should Stay Calm

Students need to be aware of the process of physician enrollment and credentialing because it will, in fact, be beneficial to them and their career. It shouldn’t come as a surprise or something unexpected to all the residents who want to land the perfect job.

Rejection on account of Glitches

If there are issues or discrepancies in the physician’s history or career, you must drop that applicant and move to the next one. There is a ‘no tolerance attitude’ when it comes to patients’ health.

Physician Enrollment as a Medicare Provider

Medicare provider enrollment application or CMS-855 is the validation form that deals with the enrollment of suppliers and providers with Medicare. You have to fill it on a computer but sign it manually before mailing it. The Internet-based PECOS is a better method for a smoother enrollment process.

Medicare provider enrollment status confirms your affiliation with the program. You can check it via the National Provider Identifier (NPI) number. You will be able to bill Medicare for any treatments rendered. P3Care provides this facility by checking your enrollment status on its homepage.

What is My Medicare or Medicaid Provider Number?

National Provider Identifier (NPI) or Provider Transaction Access Number (PTAN) shows that you are an authorized Medicare provider. It is also called the Medicare Provider Number.

Rules differ from state to state for checking Medicaid provider enrollment status. A Medicaid Provider Number (MPN) confirms you with Medicaid authorizing you for reimbursements for the services offered to Medicaid patients.

Difference between Credentialing & Enrollment

There exists a difference between the two concepts but, both of them significantly relate to the authenticity of a provider for their liberation and the well-being of the institution. Their skills, licensure, training, and expertise are accepted after they go through credentialing by the health care facilities and insurance companies.

Sign of Relief

If you don’t want to face regret or false accusations for a treatment, you must demonstrate or run a physician credentialing process. To safeguard your reputation as a doctor and most of all keep the patients’ safe from unprofessional and non-verified practitioners.

Define Credentialing

Physician credentialing is a screening process. The process involves all the background checks such as degree verification, licensure, and training years showing your integrity and eventually confirming your place in a healthcare facility. It is a vital part of the hiring process.

Insurance companies, on the other hand, use credentialing to ensure providers’ addition to the network so they can bill them and reap reimbursements promptly.

Steps Involved in Transparent Credentialing

Following are the crucial steps in the verification of healthcare practitioners giving them the green signal.

• If you are looking for clinicians to work in your facility, you can ask them politely if they would be interested in getting hired and consequently credentialed.

• On an agreement, ask for relevant information and form filling and returning it.

• Be very specific asking for documents like educational details, work experience letters, licenses, certifications and malpractice suits if any. Make sure the provider submits the required data on time.

• Ask for reference letters from at least three different sources having the same credentials as the provider. They must not be their family or colleagues working in the same practice like them.

• CAQH can assist you in filtering through the information and analyzing it for correctness. For instance, you can check their education history, employment statuses, licenses, etc. via CAQH.

• Calling the references for confirmation of information provided in those reference letters.

• Verify privileges by contacting the hospitals regarding their specialties.

• It is advised not to miss any data because it might lead to severe outcomes in the future.

Outsourcing the Task

It can save you the burden of using Health Information Technology software, letting you focus on patient care, doing your primary duty diligently. Physician credentialing is cumbersome and requires steps that can get overwhelming and frustrating for the provider at times. Hence, if you are a hospital, healthcare facility, small practice or an individual provider, do give P3Care a call and let us explain the process to you. We are keen on taking your calls to assist you at 909-245-8350. We do not let a single moment pass by that could add to your financial, emotional and reputational health.

Not only you’ll be safe from malpractice suits, but your patients will put their trust in you when you are credentialed. It makes you ethically or morally free from any liabilities.