Verisys

MARCH 6, 2025

Credentialing involves a detailed review of a provider’s qualifications, including their: Education Work experience Certifications Licenses Professional standing This process ensures that patients see professionals who are properly trained and certified to provide the level of care they require.

Licensing 52

Licensing Compliance Nurses Malpractice 52

Verisys

APRIL 3, 2025

Data inaccuracies: A misspelled name, incorrect license number, or missing documentation might seem minor, but they can lead to license and certification rejections, compliance violations, and delayed insurance reimbursementspotentially causing financial and operational headaches.

US Department of Health and Human Services 52

US Department of Health and Human Services Licensing Compliance Malpractice 52

MedTrainer

MARCH 30, 2024

Step-By-Step Provider Enrollment Process There are many reasons provider enrollments are delayed: incorrect information, missing documents, busy credentialers, and slow-moving payers. However, there are ways to leverage enrollment checklists and technology to ensure everything you need for a smooth application process happens the first time.

Malpractice 98

Malpractice Licensing Medicaid Medicaid 98

MedTrainer

AUGUST 2, 2023

Thoroughly reviewing and verifying credentials helps organizations identify any gaps or issues that may pose risks to patient safety, such as expired licenses or malpractice claims. Fines, medical malpractice claims, and patient harm are concerns if credentialing isn’t properly managed. Risk Mitigation.

Malpractice 97

Malpractice Compliance Licensing Due Diligence 97

Verisys

MARCH 6, 2025

Preventing documentation from falling through the cracks can help ensure patients receive the medical care they deserve. Consider a hospital hiring a new physician based on an old record that doesnt reflect a recent malpractice claimthis oversight can lead to severe legal and reputational consequences.

Compliance 52

Compliance Licensing Doctors Malpractice 52

Healthcare IT News - Telehealth

JUNE 26, 2023

We’re seeing a “rising of all ships” as people get more used to the modality and as documentation and workflows improve. They need to get clarity around what they're allowed to do legally, and certainly what their malpractice coverage will allow them to do. And why do you think this is? What's the address?

Telemedicine 194

Telemedicine Malpractice Licensing Public Health 194

The Health Law Firm Blog

JUNE 14, 2024

Proper documentation of client treatment records is crucial for defending against malpractice lawsuits, licensing board complaints, ethics complaints and Medicare or [.]

Malpractice 52

Malpractice Licensing Medicare Medicare 52

Verisys

DECEMBER 29, 2024

This includes verifying education, residency, employment history, malpractice insurance, hospital privileges, and board certifications. Credentialing services perform this verification by contacting primary sources, such as medical schools and licensing boards, to confirm the physician’s education and qualifications.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

MedTrainer

MAY 30, 2024

Healthcare credentialers must collect an average of 30 documents per provider to initiate and complete the credentialing process – also known as primary source verification (PSV). Traditionally, credentialers call the appropriate entities to verify transcripts, licenses, etc. Keeping the spreadsheet current requires continuous effort.

Licensing 52

Licensing Malpractice Medicare Medicare 52

Physician Credentialing Company

JUNE 12, 2024

You will need to gather and submit documents such as your medical license, malpractice insurance, and board certifications. Key Documents Required Medical license Board certifications Malpractice insurance Malpractice insurance Completing these steps correctly is crucial for a smooth credentialing experience.

Malpractice 52

Malpractice Licensing Nurses Compliance 52

Physician Credentialing Company

NOVEMBER 26, 2024

Credentialing refers to the verification process in which the evaluation of a provider’s educational degrees, medical license, and training certifications is done to check their legitimacy. Preparation Stage This stage refers to the documentation gathering, CAQH profile formation, and application filing.

Malpractice 52

Malpractice Licensing Doctors Compliance 52

MedTrainer

FEBRUARY 11, 2025

If its not documented, it didnt happen. Policies and Procedures NCQA credentialing standards require that all healthcare organizations have a well-defined credentialing and recredentialing process for evaluating and selecting licensed independent practitioners to provide care to its members.

Licensing 52

Licensing Malpractice Compliance 52

Physician Credentialing Company

DECEMBER 9, 2024

Along with having necessary educational degrees and medical licenses, maintaining such credentials is also important and comes under credentialing. Generally, credentialing specialists verify the educational degrees, medical licenses, experience certificates, and training programs. What do we mean by maintaining credentials here?

Malpractice 52

Malpractice Licensing Compliance Regulatory Compliance 52

MedTrainer

MAY 7, 2024

We’ll walk you through the steps in enrolling your providers with UnitedHealthcare, the information and documents you need, and the best practices to follow. This blog will highlight how credentialers can navigate UnitedHealthcare provider enrollment. Why Is Payer Enrollment Important for Healthcare Providers?

Malpractice 52

Malpractice Licensing Medicaid Medicaid 52

Medisys Compliance

MARCH 21, 2023

By credentialing doctors, insurance companies can ensure that their customers receive high-quality care and that the doctors they work with are qualified and licensed to provide the care they need. By verifying a doctor’s credentials, insurance companies can mitigate the risk of malpractice claims and ensure patient safety.

Doctors 52

Doctors Malpractice Licensing Medical Billing Outsourcing 52

HIT Consultant

SEPTEMBER 19, 2021

According to CRICO’s national CBS Database, 66% of malpractice cases in telemedicine from 2014 to 2018 were connected to misdiagnosis. Particularly the certification and license are one of the main challenges for nurses in telemedicine. Pandemic allowed those who were hesitant to try out telemedicine. Misdiagnoses. On-demand nursing.

Telemedicine 98

Telemedicine Licensing Nurses HIPAA 98

MedTrainer

JULY 22, 2024

It provides a centralized system for collecting, storing, and managing all the essential data and documentation related to a healthcare professional’s background, including education, training, certifications, licenses, work history, and malpractice history. Download the guide to Essential Credentialing Data.

Licensing 52

Licensing Compliance Malpractice Hospitals 52

MedTrainer

APRIL 27, 2024

Known for requiring a high level of documentation, OSVs add additional pressure and unique protocols regarding HRSA credentialing. Not to mention, HRSA-funded organizations typically have a wide range of provider types, which means differing processes, requirements, and documentation. Government-issued picture identification.

Licensing 52

Licensing Compliance Malpractice Governance 52

Physician Credentialing Company

JULY 15, 2024

By validating staff competence, it reduces the likelihood of malpractice claims and legal issues. It also involves checking for any disciplinary actions or malpractice history. This includes verifying licenses, liability insurance, and education history. Healthcare facilities benefit financially from credentialing as well.

Malpractice 52

Malpractice Compliance Licensing Medical Billing 52

MedTrainer

AUGUST 9, 2023

The exact timeline depends heavily on the complexity of the provider’s background, the efficiency of the organization’s credentialing process, and the completeness of the provider’s documentation. What Documents and Information Are Required? Licenses and Certifications. Malpractice Insurance. Work History.

Malpractice 52

Malpractice Licensing Compliance 52

Verisys

JANUARY 11, 2022

The first documentation of medical credentialing can be traced to 1000 BC by the ancient Persian, Zoroaster, in which physician licensure was outlined in The Vendidad, the book of the law. I-9 documentation listed as List A or List B or List C as defined on the form. Malpractice history and hospital sanctions. Certificates.

Malpractice 52

Malpractice Licensing Health Insurance Hospitals 52

Physician Credentialing Company

JANUARY 14, 2025

Malpractice Insurance: Address liability coverage. Credentialing Requirements: Does framing equal compliance with credentialing and licensing standards? Incomplete Documentation: Time lost due to lack of or wrong documentation. Malpractice Claims: Lawsuit history or any kind of settlement.

Licensing 52

Licensing Malpractice Regulatory Compliance Compliance 52

MedTrainer

MARCH 22, 2024

We’ll walk you through the steps in enrolling with Cigna, the information and documents you’ll need, common challenges you may encounter, and best practices to follow. The challenge is meeting each payer’s unique provider credentialing and enrollment process. In this blog, we’ll highlight how to navigate Cigna provider enrollment.

Malpractice 52

Malpractice Licensing Hospitals 52

MedTrainer

MAY 15, 2024

Since surveyors are likely to perform an unannounced audit to review the provider credentialing files for a random provider document or recredentialing date, having everything stored in MedTrainer’s credentialing platform is really helpful. Make it easy for providers to submit documents. Primary Source Verification. Background Checks.

Malpractice 52

Malpractice Medicaid Medicaid Licensing 52

Verisys

AUGUST 17, 2023

This helps guarantee that all practitioners in your organization meet the requisite licensing and certification requirements. Mitigating liability and legal risks Malpractice claims and legal disputes can financially and emotionally drain healthcare providers and organizations. Here at Verisys, we make credentialing easy.

Malpractice 52

Malpractice Licensing Compliance Medicaid 52

MedTrainer

JULY 28, 2023

This ensures that medical facilities are not engaging in malpractice and following program rules and regulations. Run exclusion checks regularly and document the results. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers. What Is the Scope of an OIG Inspection?

Fraud 98

Fraud Compliance Medicaid Medicaid 98

MedTrainer

SEPTEMBER 20, 2023

Legal costs, settlements, and increased malpractice insurance premiums can put financial burdens on ASCs found guilty of negligent credentialing. Document a Standard Process Establish a standardized credentialing process that outlines the specific criteria and requirements for granting privileges to providers at a given facility.

Malpractice 52

Malpractice Licensing Due Diligence Compliance 52

MedTrainer

JULY 10, 2023

Credentialing organizations verify that healthcare providers hold valid and unrestricted licenses to practice medicine and any additional certifications relevant to their specialties. This involves checking for any disciplinary actions, malpractice claims, or adverse events related to the provider’s practice. Peer references.

Malpractice 52

Malpractice Compliance Licensing Hospitals 52

MedTrainer

OCTOBER 29, 2023

Physical License Only California currently provides physical licenses for practitioners. This wallet-size license requires holders to scan, photocopy, or take a picture for recredenialing or verification. Make it easy for providers to submit documents. Primary Source Verification. Work History and Reference Checks.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

MedTrainer

DECEMBER 20, 2023

Both licensing and credentialing processes are pivotal in upholding the integrity and safety of healthcare delivery in the state of New Jersey. The New Jersey State Board of Medical Examiners oversees medical credentialing and licensing within the state. Primary Source Verification. Payers in New Jersey have specific requirements.

Licensing 52

Licensing Medicaid Medicaid Malpractice 52

MedTrainer

MAY 29, 2024

Controlled Dangerous Substance (CDS) Required The Oklahoma State Bureau of Narcotics and Dangerous Drugs Control requires registration as well as a controlled dangerous substance (CDS) license. This is in lieu of a DEA license. Make it easy for providers to submit documents. Payers in Oklahoma have specific requirements.

Licensing 52

Licensing Medicaid Medicaid Malpractice 52

Physician Credentialing Company

JANUARY 23, 2025

Fill in and Upload the Documents Gather all of the supporting documentation you need, including your professional license, insurance card, board certification, references, and any other documentation related to your practice. Documentation: These include diplomas, certificates, insurance forms, hospital privileges etc.

Licensing 52

Licensing Compliance Malpractice Hospitals 52

MedTrainer

APRIL 18, 2024

With a whole new group of provider enrollments starting from scratch, credentialers will likely be juggling towers of documents and data for the foreseeable future. Credentialing Documentation: Behavioral health providers must gather and submit extensive documentation for the Medicare enrollment process.

Medicare 52

Medicare Medicare Licensing Compliance 52

Physician Credentialing Company

OCTOBER 25, 2024

These codes are crucial in ensuring that medical services are accompanied by the right documentation and billing practices making the healthcare system effective. Differences between 90834 and similar codes, documentation requirements, and CPT code 90834 reimbursement tips will also be discussed. Who can Bill CPT Code 90834?

Licensing 52

Licensing Medical Billing Telemedicine Medicare 52

Physician Credentialing Company

JULY 2, 2024

Educational Qualifications Providers must hold a valid license to practice in the state where they intend to work. This involves providing a copy of the license and verification from the licensing board. Licensure Documentation of completed residency and fellowship training programs is required.

Licensing 52

Licensing Compliance Nurses Malpractice 52

Verisys

FEBRUARY 2, 2025

They then verify that the documentation is accurate, genuine, current, and in good standing, ensuring compliance with all credentialing requirements. Each healthcare facility may use its own methods to collect and verify information, but they must adhere to the same documentation requirements.

Hospitals 52

Hospitals COVID-19 Licensing Medicare 52

MedTrainer

APRIL 18, 2024

Credentialing Delays: The credentialing process can be lengthy, often involving gathering and verifying extensive documentation, including education, training, licensure, certifications, malpractice history, and references. Surveyors will often ask for a specific document or date, so the credentialer has to be ready!

Licensing 52

Licensing Malpractice Compliance 52