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What is Physician Credentialing?

Physician credentialing, or the process of organizing and verifying the professional records that qualify a doctor to practice medicine, is critical in ensuring patient safety and risk management. A file must be maintained by organizations that includes primary source verification of the practitioner’s education, training, certificates, and licensure. The process can be challenging, however, with a significant number of physician credentialing applications containing missing, outdated, or incomplete information, causing a significant delay in credentialing. Regulations differ from state to state so it is important that physicians understand their state’s credentialing regulations. To speed up the process of physician credentialing, organizations should start the process immediately when a new physician is being brought on board; use technology where applicable; stick to a series of hard deadlines related to the medical credentialing process; ensure that a physician’s Curriculum Vitae (CV) is fully updated; make all supporting documents electronically accessible; check for updates and changes to state laws; go through each payer’s application closely; and encourage regular updates to the Coalition for Affordable Quality Healthcare (CAQH) credentialing program.


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Post By Ken Shafton (1,718 Posts)