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Some Things that You Must Know About Physician Credentialing There are credential physicians in managed care insurance companies, physician offices as well as hospitals. You have to understand that credentialing is actually the method of getting information about the doctor or medical provider to be sure that one has the qualifications to practice medicine based on one’s specialization. When it comes to the credentialing method, there are many agencies which oversee this. Know that the URAC or the Utilization Review Accreditation Commission is known as the leading agency which monitors the credential and also the qualification standards in health care. Medical providers must go through the method of credentialing before getting hired by the medical facilities and insurance companies. You should know that physician credentialing is also called medical credentialing that will verify the education, training, quality, licensure and the ethical standing of the provider in the medical community. The credential process of the doctor starts with the medical provider submitting information to the credentialing agency for review. Know that the areas of focus would definitely include board certification, education, privileges, licenses, malpractice claims, insurance and personal preferences.
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Know that the information is being collected as well as reviewed by the physician peer-review committee. The committee will actually make recommendations on the standing and professionalism of the provider in the medical community. The committees usually evaluate the ethical behavior of the medical provider.
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You should know that the insurance companies, that include the government-sponsored payers, are going to research the medical credentials of the physician prior to accepting him or her into the group of those participating providers. The Medicare and Medicaid won’t actually allow the physicians who haven’t gone through the credential procedures to bill for such services. Know that managed care organizations also have that strict physician credentialing process before the provider can be listed as participated with such insurance company. A lot of the private physician practices are credentialing doctors to ensure the quality of the delivery of care. You must know that provider credentialing is a way to make sure that the medical providers were reviewed by the peers. This would provide higher level of trust and guarantees that the provider is licensed and board certified and has not had licenses or privileges revoked in a different state. You must know though that such cannot determine the quality of the delivery of care by the provider. So many credential committees have policies that the providers must join in periodic credential updates and reviews to ensure that their status is updated. There are those companies such as the medical practice consultants that specialize in provider credentials. Companies are going to consult with the medical facilities and the provide practices to make sure and to monitor that the physician’s credentials are updated.