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What Is Meant By Physician Credentialing?

Be it physician offices, managed care insurance companies, laboratories and hospitals, all are credential physicians. Credentialing is basically the act of obtaining info about medical provider or doctor to evaluate their qualifications to practice their specialty profession.

In reality, there are many different agencies today that oversee physician credentialing process. Actually, URAC or Utilization Review Accreditation Commission is deemed to be one of the leading agencies that monitors the qualifications standards and credentials in health care. Medical providers must be able to pass the process of credentialing before they could be hired by insurance companies and medical facilities.

As a matter of fact, medical credentialing is the other term used to call physician credentialing and this verifies the licensure, training, education, quality as well as overall ethical standing of the healthcare provider in medical community. The credential process of doctors start with medical provider submitting information to credentialing agency for review. Some of these areas of focus consist of education to verify the medical school as well as any post graduate training, board certification, to know specialty training and certification, licenses in which the doctor holds licenses, background check that is done to see if the person has any criminal history, malpractice claims that is used to check for malpractice claims or awards, malpractice insurance, which ensures that there’s appropriate level of insurance, resume detailing work history as well as personal references.
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The physician peer review committee will gather the information and review it. What this committee will do is make recommendations regarding the standing and professionalism of the provider in the medical community. In most instances, the committees are evaluating the medical provider’s ethical behavior.
Where To Start with Credentialing and More

As a matter of fact, insurance companies including government will research for medical credentials of the physician before accepting him or her into the group of participating providers. Well more often than not, they will not be accepting physicians who have not gone through physician credentialing to bill for services. Managed care organizations implement strict physician credentialing procedure before a provider can be listed as part of the insurance company. Truth is, many physicians practices are also credentialing their doctors to guarantee the quality of care delivered to patients.

Provider credentialing is so important because this gives assurance to patients that the medical providers attending them are evaluated. This only set high level of trust as well as assurance that the physician is board certified and licensed and not had privileges revoked in other states. This on the other hand can’t determine the quality of care provided but it is something you shouldn’t be worried about as credential committees implement policies wherein providers have to take part into periodic credential reviews and updates to keep their status active.

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