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What Is Meant By Physician Credentialing? From physician offices, managed care insurance companies, laboratories and hospitals are all credential physicians. Basically, credentialing is the act of obtaining information regarding a medical provider or doctor to assess their qualifications to practice their specialty profession. There are many agencies that are overseeing the 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. Before medical providers can be hired by insurance companies and medical facilities, they ought to pass first the process of credentialing. As a matter of fact, physician credentialing is sometimes called as medical credentialing and will verify licensure, training, education, quality as well as overall ethical standing of the healthcare provider in medical community. The credential process of doctors begin with medical provider submitting info to credentialing agency for review. A few of the areas of focus consist of board certification, to know specialty training and certification, education to verify the medical school as well as any post graduate training, licenses in which the doctor holds licenses, malpractice insurance, which ensures that there’s appropriate level of insurance, malpractice claims that is used to check for malpractice claims or awards, background check that is done to see if the person has any criminal history, resume detailing work history as well as personal references.
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The information is then gathered and reviewed via physician peer review committee. These committees are going to make recommendations to the standing and professionalism of the provider in the medical community. Normally, the committees evaluate the medical provider’s ethical behavior.
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Basically, the insurance companies including government as well will research for the medical credentials of the physician before they decide to accept him or her into the group of participating providers. Well most likely, they are going to immediately deny any physicians who have not undergone 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. In reality, many physicians practice credentialing their doctors to guarantee the quality of care delivered to patients. Provider credentialing is extremely important as this assures patients that the medical providers have been evaluated by their peers. 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. On the other hand, it can’t determine the quality of care delivered by the provider but this is something that you should worry about as credential committees implement policies to which providers should take part into periodic credential reviews and updates to keep their status active.