Credentialing

What is Medical Credentialing?

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September 22, 2021

In the last decade, medical errors have caused over 250,000 deaths in the United States - making it the third leading cause of death in that period. While the reasons medical errors occur can be debated, one of the most apparent reasons is credentialing.

It is vital for hospitals and other health facilities to ensure that their providers are competent and have the necessary training or education to achieve competence. Providing a holistic approach to patient care, quality of care, and implementing compliance with the wide range of healthcare regulations are other reasons for hospital credentialing.

What is Credentialing for a Hospital? 

Hospital credentialing is the meticulous process of verifying that a provider is qualified to provide medical services. Although credentialing can be expensive and time-consuming, it is legally required and assures quality and safety for patients. Appropriately done, hospital credentialing also protects providers and hospitals.

As a healthcare provider, you work long hours in a high-pressure environment so gathering and filling your documents for the credentialing process may not be your primary concern. Also, you may not be aware that some of the documents you have been using for years will no longer be accepted. That's why you need to outsource to a credentialing specialist like FloatCare

What Documents are Required for Credentialing?

The Joint Commission (TJC) and the National Commission for Quality Assurance (NCQA) have laid down a list of documents that must be submitted for credentialing. These documents are:

  • State license
  • Board qualification/certification status
  • Surgical logs
  • Updated curriculum vitae
  • ACLS/BLS certification
  • Documentation of hospital privileges
  • 10-year insurance claims report
  • DEA certificate
  • Professional reference(s)
  • Immunization records
  • School diploma
  • Residency diploma
  • Driver’s license
  • Social Security card

How does a Hospital Credentialing Process Work?

Different hospitals and medical facilities have their unique recruitment process. However, after making a shortlist of the successful healthcare provider(s) they intend to hire, the credentialing process is mostly the same. Credentialing for a hospital provider(s) can be split up into a three-step process that includes:

Verification and Assessment

Once the successful applicants have been notified, they will submit the necessary documents as listed above for complete verification and a comprehensive assessment of their qualifications. 

Privileging

Hospitals can grant privileges for a physician to practice at the hospital once they have approved their credentials. An individual with privileges is authorized to practice a specific type of medicine within a hospital. Privileges in a hospital fall into three types: 

  • Active or admitting: A provider with active or admitting privileges can admit patients to the hospital.
  • Courtesy: A provider with courtesy privileges can admit patients to the hospital and give the medical treatment needed while the patient is in the facility in a limited capacity.
  • Surgical: A provider with surgical privileges can perform surgery and other medical procedures.

Enrollment

An organization's provider enrollment, also called payer enrollment or the placement of providers on insurance plans, networks, or Medicare and Medicaid so they may be reimbursed for the services rendered to patients.

How Long Does Credentialing for Hospital Take?

According to guidelines, the credentialing process typically takes 90 to 120 days. Sometimes, the process will take less than 90 days, while other times, it may take over 120 days. As medical credentialing is a complex process, it is advisable to hire experts like FloatCare

Streamline Your Hospital Credentialing Process With FloatCare

The credentialing process might seem simple at first glance. Still, there is a high possibility that you will encounter a host of problems like errors in documents, time taken for processing, and issues with insurance companies. Let FloatCare help you with your hospital credentialing needs.

The credentialing experts at FloatCare have a proven track record in the field and have solved thousands of credentialing solutions for healthcare experts like you. 

We offer a comprehensive service that includes everything needed to complete the application, screening, and admission review, including gathering documents and submission of forms. This saves you time so you can concentrate on your practice.

Sign up today!

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