7 Simple Steps for Physician Credentialing

September 28, 2021

In the healthcare industry, physician credentials are worth their weight in gold. A credential proves that an applicant has the training and knowledge required to do their job correctly — which is vital when that job is caring for the health and well-being of others.

It is a physician’s job to earn their credential, keep it current, and behave appropriately to maintain it. And if you work in HR, it is YOUR job to make sure any new hires have that credential. Here are a few tips to help make physician credentialing a little easier and more effective.

Start Early

First and foremost, it is important to give yourself enough time to do a thorough check on any incoming physician. A rushed physician credentialing process will almost certainly lead to mistakes, and those mistakes can be very costly!

In most cases, you can complete credentialing in 90 days. However, it’s best to give yourself even more time (we’d suggest at least 150 days). This ensures that you have plenty of time to work with each payer that will be reviewing your new physician.

Hire a Third Party Company

The credentialing process is very important — but it can also be tedious, lengthy, and easily overwhelming. This is why many offices ask their new physicians to help with the application process. However, if you ask us, it can be even more helpful to outsource the process to a physician credentialing service.

These professionals will take care of the physician credentialing for you, so your HR department can focus on the countless other things on its plate each day. Hiring a third-party company can make the process easier and faster — particularly since physician credentialing services are more familiar with the process, and therefore are less likely to make mistakes.

Pay Close Attention to Your Applications

Speaking of mistakes, let’s talk about your application; according to some payers, as many as 85% of credentialing applications are missing critical information! This can slow down the approval process or even ensure a denial.

Make sure that any applications you submit for new physicians contain the following information:

  • Work history for all jobs since graduating medical school, including start and end dates in mm/yyyy format
  • Current policy information for malpractice insurance, as well as up to 10 years of policy history
  • Proof of admitting privileges to an in-network hospital, or a written admitting arrangement with another in-network physician
  • Any colleagues who will cover for your physician when they’re away
  • The answers to all attestations on the application, as well as a detailed response when necessary.

Stay Current with the Coalition for Affordable Quality Healthcare (CAQH)

The CAQH has a uniform credentialing program that most payers use nationwide. If a physician updates his or her CAQH profile with the most recent personal details, attestations, signature pages, and documents, there is a much higher chance that payers will approve his or her credentials that much faster.

Know Both State and Federal Regulations

Nothing is quite as frustrating as submitting a credential application and waiting weeks for a response — only to discover that the new physician is already approved with that payer, just in a different state. There are many rules for credentialing and they vary from state to state, so make sure you double check the regulations in your area before you submit an application.

Prioritize the Right Payers

Obviously, you want your new physician to be fully credentialed as soon as possible. But as we’ve mentioned, this process can be slow and tedious — so wouldn’t it be better to have a physician credentialed for the payer most of your patients use?

Figure out which payers make up the bulk of your business and prioritize getting credentialed with them first. This will allow your new physician to work with patients from that payer while they wait on credentials from any other groups.

Check All the Common Credentials Required for Physicians

Finally, it’s always wise to add a few more items to your physician credentialing checklist. Your HR team (or your third-party vendors) should take the time to make sure that any new physicians joining your facility have all the proper credentials required to do their jobs. These credentials include:

  • Education credentials
  • State licenses
  • Continuing medical education hours
  • Immunization records
  • References

 This extra degree of scrutiny will ensure that you only hire truly qualified physicians — and that is a huge benefit to both your business and any patients that step through your door.

We will admit, the physician credentialing process is no walk in the park. But if you’re careful (or if you hire the right third-party team), you can get through this process with as little stress as possible. To learn more about physician credentialing services and other healthcare compliance options, contact ComplianceLine today.