What is credentialing?
Medical credentialing involves verifying a healthcare professional's training, expertise, and proficiency to ensure they meet the standards for providing patient care. Its' primary objective is to certify that healthcare providers are qualified to deliver top-notch care and mitigate the malpractice risk.
Credentialing is typically done directly with each insurance payer with their provider relations department and it can take several months to complete.
Why is it important?
Credentialing is important for payers and patients because it assures that only authentic and certified professionals are reimbursed for medical services by thoroughly verifying providers.
Credentialing is important for providers because it ensures that they can be reimbursed for services.
Anagram's Policy
As a provider, you are obligated to be credentialed under the payer rules.
Any claims for providers that are not credentialed with the insurance payer will be placed on hold until confirmation is received that the provider is credentialed.
Anagram will not file any claims for non-credentialed providers under the name of another provider.
This is a compliance risk. If the provider begins to see patients under insurance payers they are not credentialed with, these claims may be subject to write-off if insurance approval is not backdated.
Additionally, enrollment forms will need to be signed and returned ASAP and other actions may need to be performed by the practice for EDI enrollment. These are time-sensitive.
If you need credentialing help, please let us know. Our team is happy to offer recommendations so you can get back to doing what you do best: seeing patients!