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Senior Expert Healthcare

Provider Credentialing is an essential process that both Payers and Providers manage to ensure their clinical staff is qualified and certified to practice in their network . The healthcare provider credentialing process is a pillar of quality and risk management for the healthcare industry, it’s critical for health facilities to perform their due diligence when hiring/appointing front-line medical services providers. Credentialing is the process to verifies that a physician has the necessary education, experience, training, licensure, history, and competencies to perform specified medical procedures.Credentialing process is required during the hiring/ appointing process and at other intervals afterward, this process follow practices established by regulatory and accreditation organizations such as the Joint Commission. Below is the list of main steps of verification in credentialing processBoard Certification – Verify current certificate levelSanction Check– Verify OIG sanction checkDepartment of Health and Human ServicesDEA certification/registrationWork History – extract work history from the curriculum vitaeNPI Validation – query state license and Medicaid/Medicare

Healthcare provider credentialing process is a pillar of quality and risk management for the healthcare industry, it’s critical for facilities to perform their due diligence for provider onboarding

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