This site uses cookies to improve your experience. To help us insure we adhere to various privacy regulations, please select your country/region of residence. If you do not select a country, we will assume you are from the United States. Select your Cookie Settings or view our Privacy Policy and Terms of Use.
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Used for the proper function of the website
Used for monitoring website traffic and interactions
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Strictly Necessary: Used for the proper function of the website
Performance/Analytics: Used for monitoring website traffic and interactions
Download Now How Bad Data Leads to Financial Losses Revenue loss from poor provider data management mistakes is largely driven by denied claims, billing errors, and enrollment delays. Even if a provider is unknowingly practicing with an expired license, or an unverified specialty, the legal and financial repercussions can be severe.
Download our Credentialing Reality Worksheet to find out! Download Now Credentialing Software Drives Speedy Provider Enrollments Credentialing software offers several benefits that help credentialers speed up the provider enrollment process. How much are enrollment delays costing your organization?
Would you want a provider whos been disbarred due to patient abuse or malpractice providing your care? Download Now Exclusion Checks vs. Exclusion Monitoring Same concept, different strategy, different outcomes. Working with individuals and entities on the exclusion list also vastly compromises patient safety. We wouldnt either.
Here are the key steps: Gather Training and Education Gather Licensing and Certification Gather Work History Details Gather Payer-Specific Requirements Following Application Submission Get the tools you need to eliminate delays in your provider enrollment process. Easily assign multiple enrollments to staff, update statuses, and prioritize.
Here are the key steps: Gather Training and Education Gather Licensing and Certification Gather Work History Details Gather Payer-Specific Requirements Following Application Submission Get the tools you need to eliminate delays in your provider enrollment process. Easily assign multiple enrollments to staff, update statuses, and prioritize.
Download “Compliance Reports You Can’t Live Without” for OIG reporting templates and tips. This ensures that medical facilities are not engaging in malpractice and following program rules and regulations. One of the OIG’s top priorities is to safeguard funding and protect the country’s most vulnerable citizens.
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. You can download one PDF with all your documents to further simplify your workflow.
Many other licensed healthcare providers must be credentialed: nurses, physical therapists, speech pathologists, and behavioral health therapists. For example, a healthcare organization verifies a provider’s state license by calling or searching the state license registration board. BLS/ACLS certifications status.
Here are the key steps: Gather Training and Education Gather Licensing and Certification Gather Work History Details Gather Payer-Specific Requirements Following Application Submission Get the tools you need to eliminate delays in your provider enrollment process. Easily assign multiple enrollments to staff, update statuses, and prioritize.
This includes all credential types: license to practice, board certification, work history, malpractice history, state licensing sanctions, and both Medicare/Medicaid sanctions and exclusions. This doesnt call for monthly monitoring of all credential information only monthly monitoring of the license expiration date.
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.
Imagine discovering your surgeon’s license expired six months ago, or learning that your hospital is losing millions in revenue because of inaccurate details that cause denied claims. Missing a single expired license or skipping one background check can lead to denied claims, legal liability, and damaged reputations. With 75.7%
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. Primary Source Verification. Payers in Oklahoma have specific requirements. Background Checks.
Download Now Common Challenges in ASC Credentialing Revenue is of critical importance in an ASC. Credentialing Delays: The credentialing process can be lengthy, often involving gathering and verifying extensive documentation, including education, training, licensure, certifications, malpractice history, and references.
The specialist authenticates the provider’s education, work history, licenses, and other information during provider credentialing. Additionally, the credentialing specialist may request a record of any pending and past medical malpractice cases and disciplinary actions from the appropriate authority.
Download this guide for tips on how digitization helps to speed up your credentialing process. Licenses & Certifications: Current and past medical licenses, DEA certifications, and other relevant certifications with details like issuing state, license number, and expiration date.
Familiarize yourself with any payer-specific requirements such as proof of malpractice insurance, state-approved alternatives, and specific forms like the special needs survey or disclosure of ownership statement. Identify whether you are submitting an individual, group, or delegated application to avoid confusion.
Primary source verification involves contacting original sources — such as educational institutions, licensing boards, and certification bodies — to confirm the authenticity and accuracy of the documents and qualifications provided by the provider. If the dentist is being credentialed in a state with its own portal, set that up as well.
Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment. This may include proof of licensure, certification, accreditation, malpractice insurance, DEA registration (if applicable), and other supporting documentation.
Automated Reminders: The software sends automatic reminder emails for expiring licenses or upcoming recredentialing processes for timely updates and compliance. Provider Document Uploads: Providers can upload all documents, licenses, and more through a secure link. Shorten your privileging process with this free checklist.
The interactive PDF is available through the Texas Department of Insurance, but providers or credentialers can easily download a pre-filled application from CAQH — the format changes slightly per payer, but it includes almost the same information as any other “standard” application. Primary Source Verification. Background Checks.
State licensing boards verify practitioner license type and status. The policy issuer for malpractice insurance verifies insurance coverage. Delivery of data ranges from a print-out sent by mail, a spreadsheet sent through email, a CSV download from a secure server, or an online searchable database. Unpublished Data.
State licensing boards verify practitioner license type and status. The policy issuer for malpractice insurance verifies insurance coverage. Delivery of data ranges from a print-out sent by mail, a spreadsheet sent through email, a CSV download from a secure server, or an online searchable database. Unpublished Data.
Are providers and professionals allowed to download mobile applications to mobile devices? As AIHC advises, another resource is legal advice through your malpractice insurance company. Click Here for Cross-State Licensing information. o If so, where and for how long should the data be stored? ?
For example, an individual discloses to their doctor that they obtained reproductive health care from an unlicensed person and the doctor knows that the specific reproductive health care must be provided by a licensed health care provider. Download a copy of the model attestation from OCR. What is the New Form Requirement About?
We organize all of the trending information in your field so you don't have to. Join 26,000+ users and stay up to date on the latest articles your peers are reading.
You know about us, now we want to get to know you!
Let's personalize your content
Let's get even more personalized
We recognize your account from another site in our network, please click 'Send Email' below to continue with verifying your account and setting a password.
Let's personalize your content