How to Avoid Credentialing Pitfalls To Improve Your Revenue?

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How to Avoid Credentialing Pitfalls To Improve
Your Revenue?
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Introduction
Physician credentialing is the process of
enrolling a physician with the insurance company
to ensure the physician is privileged to provide
services to the patients and get their claims
processed with that particular payer. Physician
Credentialing is essential for the physicians to
be In-Network with various government and
commercial insurance companies which can help
increase patient referrals and overall revenue.
Let us look in detail on how to avoid
Credentialing Pitfalls from impacting your
revenue.
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Plan ahead of Time

• Credentialing might seem to be an easy and simple
  process of paper works but the reality is,
  Physician credentialing if not done on time with
  accuracy can ultimately impact your revenue. Thus
  planning the requirement of physician
  credentialing process ahead of time is
  quintessential on any of the below scenarios, but
  not exclusive of
• The medical practice is adding a new physician
• The physician is starting to practice for the
  first time after medical graduation
• A physician wants to get enrolled with a new
  payor.

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Physician Credentialing Document Checklist

• The common cause of delays in Physician
  Credentialing is the submission of incorrect,
  incomplete or missed detail or supporting
  documents.
• To avoid such a miss, it is recommended to have a
  Payor-based checklist of required data and
  supporting documents that need to be attached
  with the Physician Credentialing Application.
• Almost all insurance companies require the
  physicians qualification, certification and
  work-related data to credential the physician in
  their network.

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• Pls. see below a common checklist of documents to
  be submitted along with credentialing application
• Physician personal details like Name, Age, DOB,
  Gender, SSN, etc.
• Contact details like Mailing Address, Phone
  number, Email Id
• Copy of Driving License
• Practice details like Tax Id, Practice contact
  details, Provider NPI
• Providers Educational and training Certification

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• Residency and Internship Certification
• Continuing Medical Education (CME) documents
• Copy of current state licenses
• CAQH Credentials
• Hospital Affiliations
• Work History with an explanation on career gap
• Malpractice Insurance
• Previous Malpractice History with status
• Peer References

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Complete and Accurate Documentation

• Incomplete and inaccurate application and
  supporting documents can lead to unnecessary
  delays.
• Therefore it is indispensable to deploy
  experienced staff to handle credentialing process
  along with a streamlined and timely process to
  ensure quality.
• Performing audits on regular basis can help
  identify the common reasons for repeated errors
  and delays and implement corrective measures.

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Regular Follow-ups

• Physician Credentialing can take anywhere from 90
  to
• 120 days to process.
• Insurance companies handling numerous
  applications on a day to day basis may miss out
  on your application, hence it is crucial to have
  regular follow-up with the insurance company to
  ensure timely processing of your application.

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Experienced Staffs

• Handling paper works for physician credentialing
  requires deft hands and making regular followups
  requires a team with expertise on understanding
  the nuances of each payer.
• An experienced staff can handle the core with
  accuracy to ascertain the quality and timely
  process of credentialing.
• Outsourcing Physician Credentialing is mostly
  opted due to the intricacy involved in handling
  the process and to ensure quality work by a
  professional and experienced team.

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About e-care

• e-care India is one of the pioneers in offshore
  medical billing based in India that promises to
  avoid the revenue pitfalls due to incomplete or
  delayed Physician credentialing by its services.
• With 20 years of experience in the industry,
  e-cares 3 delivery centers have been providing
  Medical Billing and Physician Credentialing
  services seamlessly to their clients.
• To know more about e-care and its services,
  contact us today at 813-666-0028 or log on
  to www.ecareindia.com

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Contact us
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e-care India - Medical Billing Outsourcing Company