How to Avoid Credentialing Denials: A Guide for Healthcare Providers
Credentialing is a critical step in the medical billing process, which can be time-consuming and complex. In this blog, we’ll go over some of the basics of credentialing in medical billing, specific steps you need to take to avoid credentialing denials, and how partnering with a dependable medical credentialing company ensures your applications are processed quickly and accurately.
Understanding the Physician Credentialing Process
Credentialing involves confirming a healthcare provider’s -credentials meet the criteria required by payers for enrollment as a network provider. This includes verifying critical information, such as education and training.
Medical staff credentialing can be a lengthy process that involves submitting various applications and supporting documentation to payers, then waiting for approval before being accepted as an eligible network provider. The extensive forms, documentation, and waiting periods can cause anxiety and delay your ability to serve patients seeking network providers and receive proper reimbursement for your services.
Additionally, improper credentialing can result in denied claims, leading to financial losses as well as dissatisfied patients . To avoid potential delays or denials, you must ensure credentialing is done timely by someone experienced in all the twists and turns of the credentialing process..
An extensive amount of information needs to be verified and submitted to payers. Make sure your provider file with both personal and professional information is complete.
There are many intricacies involved in the credentialing process, all of which show that you are a qualified, dependable provider of healthcare services. Communication between you and a highly experienced credentialing service provider is key to ensuring a smooth enrollment process.
Ensure Success With Expert Credentialing Services
If you want to avoid denials and begin your medical practice in a timely manner, you need an expert by your side. Learn more about BSI Medical Billing’s extensive credentialing services and how we can support you today.
Work With a Reputable Medical Credentialing Company to Avoid Denials
To streamline this process, you need to work with a dependable provider. Here’s how an industry professional can alleviate the stress of the credentialing process:
Obtaining and Verifying Necessary Information
A good credentialing company will be organized and know what information is required to make the process as seamless as possible. They should be able to help guide you easily through the process and take the stress out of credentialing.
Tracking the Progress of Your Applications
From initial submission to final approval, your medical credentialing company should monitor your applications and inform you of its progress with relevant organizations. If there’s an issue or if you need to submit additional paperwork, they can help you resolve these problems to avoid credentialing denials and maintain progress.
Ensuring Your Credentialing Applications Are Submitted on Time
As the healthcare industry continues to evolve rapidly, staying up to date with deadlines becomes increasingly important. By managing your applications for you, your provider can ensure everything is submitted within the proper time frame. In doing so, you can avoid automatic credentialing denials that arise from late submissions.
Responding to Inquiries From Insurers and Government Agencies
Credentialing denials can also occur when inquiries from insurance agencies or government institutions aren’t properly addressed or resolved promptly. These can include background checks or questions regarding your insurance or licensing requirements. Instead of trying to navigate these questions yourself, you can let an expert guide you through them.
Keeping You Up to Date on Industry Regulations or Changes in Procedure
Having a knowledgeable medical credentialing company in your corner can also help you stay abreast of any credentialing changes. These providers understand the constantly evolving landscape and can provide the timely updates needed to help you keep your network status.