Physician Credentialing Services

Physician credentialing is the comprehensive verification and assessment of individual physicians' qualifications, training, and professional history, encompassing MDs and DOs. This process focuses on essential credentials, including education, residency training, board certifications, licenses, and disciplinary history. It extends to physicians across various specialties, such as primary care providers, surgeons, cardiologists, and pediatricians, ensuring that each practitioner meets the necessary standards for their respective fields.

The primary stakeholders in the medical credentialing process for physicians are hospitals, medical groups, and healthcare facilities employing or contracting with them. To facilitate effective credentialing, these organizations thoroughly verify state medical licenses, board certifications, educational backgrounds, and work histories tailored to each physician's specific practice area. This ensures that the providers have the requisite qualifications and expertise to deliver high-quality care.

Efficient credentialing management is crucial for collecting comprehensive documentation, maintaining compliance with regulatory standards, and facilitating timely enrollment with insurance payers. An effective physician credentialing process allows healthcare providers to practice without delays and ensures they receive appropriate reimbursement for their services, ultimately contributing to the smooth operation of healthcare delivery.

However, these practices often face numerous challenges in their credentialing processes. Issues such as the complexity of documentation requirements, inaccuracies or missing information, and delayed provider availability can hinder timely credentialing. Additionally, the evolving landscape of healthcare regulations and payer policies complicates the process, creating significant challenges for healthcare facilities striving to maintain compliance while ensuring efficient operations.

Invensis offers expert physician credentialing services to help healthcare practices overcome the above complexities and streamline the process by: 

• Gathering comprehensive information from physicians, including personal demographics, educational qualifications, training history, licensure details, board certifications, and professional affiliations.
• Conducting Primary Source Verification (PSV) by confirming degree authenticity with medical schools' residency programs and ensuring active state medical licenses.
• Executing thorough background checks that include criminal history, National Practitioner Data Bank (NPDB) reviews, and verification of employment history for accuracy.
• Collecting evaluations from professional peers to assess the physician's clinical skills, treatment outcomes, and adherence to ethical standards.
• Analyzing the physician's malpractice history, focusing on settled claims and litigation records to identify patterns and potential risks.
• Compiling all collected data for evaluation by a credentialing committee, which assesses physician credentialing compliance with organizational standards and qualifications.
• Establishing a proven process for ongoing oversight, including evaluations of patient outcomes and periodic recredentialing every 2-3 years. 
• Ensuring adherence to federal and state regulations and accreditation standards set by the Joint Commission and National Committee for Quality Assurance guidelines.