Medical Credentialing

Why is Medical Credentialing Important

Overview :

Medical credentialing is a process used for reviewing the qualification of a healthcare provider. It includes licensing, career history, education, experience, and training. This blog covers some of the most important aspects of medical credentialing.

Summary :

  • Medical credentialing is a verification process that assures the healthcare provider is legal and competent.
  • Credentialing facilitates the hiring process and verifies whether the applicant has been involved in any malpractice case or fraud.
  • Physician credentialing plays a vital role in the success of the practitioner’s business.
  • Insurance companies require credentialing before allowing the health care providers to operate within their network.
  • Medical Credentialing builds a patient’s trust on the chosen healthcare practice and reduces the number of medical errors.

What Is Medical Credentialing?

Medical credentialing is a verification process to ensure that the provider is legal and competent. This process usually occurs after a provider applies for a position at a healthcare organization. The company then acquires and evaluates the proximity and authenticity of the documentation and administration concerning the applicant’s education, training, practice license, and work experience. Credentialing facilitates the hiring process and verifies whether the applicant has been involved in any malpractice case or fraud.

Benefits of Medical Credentialing

The process of physician credentialing is essential for both doctor and the patient as it assures that practitioners who provide care are qualified to do so. Some of the most notable benefits of medical credentialing are listed below:

1. Improves Patient Trust on Preferred Healthcare Provider

One of the most critical requirements in the healthcare system is trust-building between patients and medical professionals. It helps patients open up and discuss their perception of better care which ultimately leads to the greater acceptance of recommended treatment options. Patients need to know about their provider’s qualifications and experience to ensure their merit or expertise allow them to place their complete trust in the doctor.


2. Lowers the Risk of Medical Errors

An alarming statistic compels industry leaders to campaign for revised competency standards and exposure to disciplinary actions against healthcare providers.

‘’It is Estimated That Approximately 98,000 of the US Population Die Due to Medical Errors Annually.’’

Credentialing healthcare providers and independent practitioners help reduce the chance of medical errors that incompetent providers may make. Moreover, since electronic credentialing uses automation tools, there is no room for human error or fatigue correlated with the manual evaluation process.

3. Improves Practitioner’s Business

The process of medical credentialing permits health care providers to accept patients with health insurance. As most Americans have health insurance plans yet most of the patients want to meet the same doctor every time.

Therefore, physician credentialing will result in accepting more patients, which, in turn, increases the revenue of the practitioner’s business.

4. Cost Affordable

With the current pressure of the healthcare budget, clinics are under increased stress to lower their operation costs and streamline hospital processes. With electronic credentialing, healthcare organizations can migrate from a paper-based system to a cloud-based computing solution. It will reduce costs without affecting people’s safety and health.

5. Helps in a Hiring Process

The credentialing process involves a thorough evaluation of the qualifications, experience, career history, and demonstrated skills of a medical professional, including their licenses, training, and residency. This process plays a vital role while hiring a new doctor or physician. It helps to ensure that the recruited healthcare provider is qualified and eligible for the position. Besides, credentialing is needed by insurance companies before allowing the provider to operate within the network.

Medical credentialing is frequently becoming an essential part of the healthcare system. It can protect healthcare organizations from several liabilities, like financial loss, risk of compliance violations, untrained healthcare providers, and undesired lawsuits. In order to have a regular patient base, a medical expert should think of being credentialed with insurance providers.


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