Physician Provider Credentialing: What Is It And Why Is It Important?

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Physician/Provider Credentialing
What is it and why is it Important?
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What is Physician/ Provider Credentialing?

• Provider credentialing is the process of
  compiling and verifying complete information
  about a medical practitioner for the purpose of
  validating physicians expertise and ensuring
  qualitative service to patients.
• Physician credentialing is a crucial step to get
  enrolled with any insurance company and claim
  processing

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Process of Physician Credentialing

• The process of Physician Credentialing is a
  detailed step by step procedure of collecting,
  assessing and verifying the Medical Practitioners
  credentials, documents and certification to
  ensure the physician meets the standard of
  quality patient care.
• Credentialing Applications are to be duly filled
  with all personal details, contact details and
  professional work history.

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Physician Credentialing Check list

• Physicians current updated CV with exact
  beginning and ending dates of Medical Schooling,
  Residency, Internship, Work History, career gaps,
  etc.
• Board Certifications and Professional school
  certification
• Certification of completion for Internship,
  Residencies, Fellowship and all educational
  activities including CMEs (Continuing Medical
  Education)

• Details of Hospital Affiliation and Privileges
• Copy Professional License
• Copy of current State Licenses
• CAQH and PECOS Credentials
• Copy of SSN and current Driving License
• NPI National Provider Identification
• DEA, CDS and W-9 Form
• Malpractice Insurance Certificates

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Why is Physician Credentialing Important?

• Credentialing with Insurance Company is mandatory
  to enable the physician to be able to see the
  patients and get reimbursement from the
  Insurance. Insurance Companies may deny payments
  for Physicians who are not Credentialing with
  them. Physician Credentialing is also essential
  to imply the provider is legitimate and
  proficient, and showcase integrity to draw
  patients to your practice.
• By getting credentialed with a payor, the
  provider gets increased patient visits from the
  network which indirectly reflects in improved
  revenue for the practice.

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Who Needs to Get Credentialed and When?

• Any physicians who need to send their claims to
  an Insurance Company and get the reimbursement
  should get credentialed.

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Who Needs to Get Credentialed and When?

• Listed below the various scenarios which requires
  the physicians to look out for Credentialing
  Services.
• New physician who wish to start seeing patients
• Providers who are joining a new practice/hospital
• When switching employers
• Shifting from one state to another
• Those who get affiliated to new practices or
  groups
• Physician looking to enroll with new payers

Providers are also required to maintain their
credentialing privileges by re-credentialing on
time to ensure the billing process is intact.
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Outsourcing Physician Credentialing Services

• Handling Physician credentialing without any
  prior experience can be difficult and may lead to
  multiple miss and rejections. A Medical Practice
  where one or more physicians are required to be
  credentialed, will need expertise support to
  handle and complete the credentialing process on
  time to ensure their claims are processed timely
  and cash flow is sustained. It can be laborious
  and complex for physicians to handle the
  credentialing by themselves along with daily core
  of patient care, however with an Outsourced
  Physician Credentialing things are now easier and
  stress free.

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MGSI Physician Credentialing Services

• MGSI has expertise handling credentialing
  Services with different payers and our Physician
  Credentialing team are experts in handling each
  application adequately to meet the elected
  insurance carriers requirements. To know more
  about MGSI and our services, call 1-877-896-6474
  or log on to www.mgsionline.com

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Contact MGSI
Your Partner for Medical Billing Services
Phone [phone]
Website www.mgsionline.com