Credentialing Hold Ups!

Are you a provider who has been denied entrance into a medical network?

What about delays; have you experienced extremely long waiting periods to be approved as a credentialed medical provider?

According to NAMSS, these are the examples of red flags that will hold up your credentialing with a network or hospital:

  • Resignation from a medical staff at any time in an applicant’s career.
  • Reports of problems in an applicant’s professional practice.
  • All past or pending state licensing board, medical staff organization, or professional society investigative proceedings.
  • Unexplained or unaccounted time gaps.
  • No response to a reference inquiry from an applicant’s past affiliation.
  • Disciplinary actions by medical staff organizations, hospitals, state medical boards, or professional societies.
  • Any claims or investigations of fraud, abuse and/or misconduct from professional review organizations, third-party payers, or government entities.
  • Little or no verified coverage from a professional liability insurance policy.
  • Jury verdicts and settlements for professional liability claims (which should still be individually reviewed).
  • Inability to maintain a medical practice within the facility’s service jurisdiction for any amount of time.

Today, medical networks have tried to streamline their processes, yet some have only complicated them even more!

Those who have outsourced overseas have lost streamline in communication, some who created 101 departments hoping each phase could keep their part in order also added to the complexities of credentialing.

We miss the good ol’ days when you have one credentialing representative to contact, and they would see you through the entire process!

Networks have created online portals and replaced phone numbers with emails only. You can only communicate through your keyboard and pray to God someone on the other end received it!

No more rushing through enrollments, nope!

Now more than ever, you, the provider, will spend countless hours trying to join a network.

Outsourcing your provider enrollments are vital to saving money and time. For more information on how we can help please call us at 909-457-0056 or send us a message through our contact form!

 

 

 

 

 

 

See the entire PDF: http://www.namss.org/Portals/0/Regulatory/NAMSS%20Roundtable%20Credentialing%20Best%20Practice%20Criteria%20White%20Paper.pdf