Credentialing Services Archives - InfoHub Thu, 21 Jul 2022 14:02:13 +0000 en-US hourly 1 Credentialing Services Archives - InfoHub 32 32 Impact Of Credentialing On Your Practice? Wed, 12 Jan 2022 12:15:22 +0000 Medical credentialing has a vital role in influencing your medical billing process. It is the primary reason for building patients’ trust in your procedure with the communication you maintain between your patient and the insurer. Therefore, Credentialing is considered a high priority and must be performed before hiring a healthcare provider or during the hiring procedure to ensure that all the data is up-to-date with your provider.

Medical credentialing is critical for ensuring that a healthcare provider is legal and skillful. When a medical provider applies for a position at your healthcare organization, the credentials verification phase of our Medical credentialing process begins. Your organization must then verify that the applicant is who you believe they are and hold a current and unimpaired license in the state of practice. Additionally, to grant the fully competent privileges and not violate any laws that would impede their ability to practice. 

Benefits you get by choosing the Medical credentialing by Info Hub:

Medical credentialing keeps healthcare organizations from losing money. One of the most critical financial reasons for properly credentialing medical staff is to ensure compliance with state and federal regulations. The payer may refuse reimbursement when your healthcare organization seeks reimbursement from a commercial insurance carrier or a government program for services offered by a nurse, pharmacist, aid, physician, or another provider. If the refund has already occurred, the healthcare organization may be fined, subject to civil monetary penalties, and required to repay the total reimbursement, sometimes in multiple fines. 

As a result, it is your healthcare organization’s responsibility to make sure that a provider’s credentials are verified upon hire and continue to be verified through a process of continuous monitoring, which Info Hub credential services can help you with.  

Credentialing shields healthcare organizations from legal action. 

While Medical credentialing is a necessary but preventative measures method that encompasses the bases of compliance and best practices, there are still situations beyond the control of healthcare providers and administrators of the healthcare organization.

In the situation of a lawsuit, the law will consider whether a healthcare organization is following federal requirements, has chosen to conform with quality standards organizations through current certifications and accreditations. Finally, an organization is the best when examined by the justice system when it has selected the way of best practice compliance, which goes above and beyond regulatory requirements. Therefore, to save your organization from facing any lawsuits, it is imperative to follow an appropriate credentialing process that maintains the authenticity of the people in your organization.

Medical credentialing services alleviate administrative burdens. 

As healthcare organizations expand with multiple hospital locations, urgent care centers, and specialty centers, and as the practice of telehealth grows—all while many administrators work remotely—delegating Medical credentialing services to Info Hub can ensure continuous conformity and keep your organization up to date with changing regulations, waivers, and procedures.  

For the ease of practicing telemedicine, the Medical credentialing technology of Info Hub employs a process of continuous monitoring against multitudes of primary sources and cloud-based access across areas, departments, and states. As a result, it is an effective method of staying ahead of the credentialing process. 

Medical credentialing safeguards your patients. 

A provider may be barred from practicing medicine for issues unrelated to their ability to practice, like defaulting on a student loan or allowing their license to lapse. The addition of the other primary-source data by our Medical credentialing services brings the degree of transparency for organizations that have contact with patients to the next level. For example, it would be critical to know that the pediatric ICU night nurse is not an offender and that the caregiver has not committed criminal offenses in other states.  

Qualifications and performance reviews by a supervisor and written peer reviews are required as part of the credentialing process. However, patients will not have access to the data and will thus be unable to be a part of informed healthcare decisions. It is the healthcare organization’s responsibility to ensure the safety of its patients and the safety of its entire staff, so outsourcing credentialing services to Info Hub will assist you in maintaining a high level of security.

Contact Info Hub for credentialing services in your city- 

The requirements of the credentialing process differ from one accrediting entity to the next, as well as from state to state. In short, keeping track of what information needs to be collected and submitted and in what format can be perplexing. Info Hub medical billing services can handle all of your credentialing needs.

Get in touch with our experts at +1 (888) 694-8634 or 0422 4212 455 or Visit us at

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Have You Initiated Credentialing/ Re-credentialing For Your Practice? Wed, 29 Dec 2021 08:23:23 +0000

The credentialing and re-credentialing processes are significant elements of your health plan quality management program. The credentialing and re-credentialing processes serve to ensure that qualified professionals in your health plan provider network are capable of meeting the needs of those seeking and receiving services.

Credentialing and re-credentialing is an ongoing evaluation process that ensures practitioners’ current competency by confirming individual practitioners’ training and ability in specific specialty areas. This level of review is designed to ensure that individual practitioners have demonstrated the necessary training, experience, qualifications, and ongoing competence for the services they deliver.

The rules for credentialing and re-credentialing vary based on the type of provider. Before providing services to members, physicians, nurse practitioners, physician assistants, psychologists, and all other health professionals registered to bill independently or provided services, they are licensed to offer and must be credentialed.

Suppose your health plan delegated any credentialing and re-credentialing or provider selection responsibilities. In that case, a health plan must retain the right to approve, suspend, or terminate any chosen providers and revoke the delegated function if the charged process is not performing satisfactorily.

The Application Process   

Accomplishing in-network status starts with an application. When applying, make sure you use the most recent version or copy of the insurance carrier’s application form. Using an out-of-date version can cause application delays, if not outright rejection. Also, make sure that all of the sections are filled out.

Why Credentialing/ Re-credentialing is Important?

Many people, including those in the medical billing services industry, are unaware of the significance of credentialing. As a result, industry leaders have fought for the authority to improve competency standards for healthcare professionals by requiring provider disclosure and accurate recordkeeping.

The idea is to ensure that the qualifications of each provider in your business or clinic are transparent. Providers have been charged with duties above their qualifications and experience due to simple human faults. Physicians with an expired license may still practice in specific circumstances. In the end, this can be a nuisance for professional clinics that employ a variety of medical providers and a risk to patient safety.

Many office and clinic owners are now more conscious of the necessity of rapid and accurate credentialing and re-credentialing services. As a result, they have recruited experienced healthcare consultants to handle crucial elements of business, such as medical billing and other services.

Performing proper credentialing of new clinicians brought into the practice is not only mandated by payers, but it is also critical to the clinic’s success and reputation. When everyone on staff has been credentialed and a thorough attempt is made to conduct re-credentialing services as needed throughout time, risk and cost are decreased.

Outsourcing Credentialing and Re-credentialing Services

Our healthcare consultants may assist with rapid and accurate credentialing or re-credentialing services as needed, in addition to all of the medical billing services, training, and support available at Info Hub.

Outsourcing these services can help your in-house medical billing department reduce effort and speed up the certification process for new and existing providers. In addition, by centralizing data for each provider to meet compliance requirements for insurance payers and Medicare systems, this solution helps to decrease fraud and waste.

Key Points

  1. All licensed individual health care practitioners must be credentialed to participate in the Info Hub networks and see Info Hub members.
  2. Info Hub adheres to industry standards for credentialing and re-credentialing of healthcare workers.
  3. The National Committee on Quality Assurance (NCQA) and the Centers for Medicare & Medicaid Services (CMS) set credentialing standards (CMS).
  4. The Council for Affordable Quality Healthcare (CAQH) and other state-specific institutions created a contract with services like Info Hub to collect credentialing and re-credentialing application data and Aperture CVO to validate required components of the credentialing application and process.

Healthcare organizations and providers must obtain credentialing from as many payers as possible so that patients can continue to utilize their plans in the future. Credentialing and re-credentialing ensure that a physician or healthcare organization satisfies the payer’s requirements.

So, send your credentialing and re-credentialing documents to Info Hub, and we’ll handle the rest.

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