The Prominence of Provider Credentialing – Learn how it dates back

Prominence of Provider Credentialing

The Prominence of Provider Credentialing

It all goes back to 1000 BC, when provider credentialing placed itself as one the most crucial part of healthcare services. Though there have been ongoing modifications over centuries, the content of credentialing has been consistent - verifying the providers' education, training, experience, expertise and the desire to provide medical services. In 1990 national organizations were formed for credentialing of medical providers, and around the same time, the National Committee for QualityAssurance(NCQA) issued process and method guidelines of credentialing medical providers.

The guidelines emphasize that healthcare providers undergo stringent investigative protocols, ensuring that all patients receive best in class healthcare. All that really matters to patients is an assurance that their healthcare providers' credentials are certified through the healthcare credentialing process. This helps them feel at ease while undergoing any treatment. In the provider situation, colleagues are treated as equal; whereas in a healthcare facility situation, they value quality healthcare, along with their patient's good health.

In the health insurance and revenue cycle sector, it is critical to know that incomplete/illegitimate credentialing may result in delayed or denied reimbursement for the services offered. To make it worse, statutory compliance violations could even lead to grave consequences for everyone involved and can lead to monetary implications and criminal trials.

It has been years that provider credentialing and Enrollment has been ignored as a powerful measure of healthcare management practices; however, it is not too late that fast growing practices have started to realize that these measures lay a key impact on avoiding compliance issues and favouring their financial performance.

Bikham has been instrumental in assisting a highly considerable number of practices with their administrative processes, as well as assisting their staff through compliance guidelines and parameters. Look at how a Urology group collected $2.2 million in claims held due to Enrollment issues within 14 weeks by clicking here. Bikham extended a customized approach to rectify any errors and helped the group enhance their revenue by getting rid of the entire backlog, resulting in an incredible cash flow in the first 9 weeks itself. Recognizing the value of Bikham’s results, the Urology group continues to work with Bikham’s payor Enrollment team to enrol its newly hired providers.

Bikham Provider Enrollment and Provider Credentialing services are highly focused on helping you reduce your on-hold claim value, ensuring compliance, while standardizing the administration processes. Reach out to our specialist today and head the right direction.

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