Why Is Credentialing Important? Generally defined, medical credentialing involves the process in which insurance networks, hospitals, and healthcare organizations take the time to work and confirm all of the qualifications of a healthcare professional.


This is a process that is extremely important for both the doctor and the patient due to the fact that it ensures that those healthcare professionals who are providing care to individuals are qualified to do so.


Here are four reasons as to why medical credentialing is important.



One reason as to why medical credentialing is important is because there are fewer restrictions. When it comes to medical credentialing, this is a process that has helped to widen the overall scope of services that are offered by all kinds of insurance plans with fewer amounts of restrictions placed on pre-existing conditions. These days, no insurance company is permitted to charge an individual more, deny payment on vital health benefits, or deny any individual coverage due to pre-existing conditions. This is something that has been able to prevent patients from obtaining the services of specialists who would otherwise be out of work.



Another great reason as to why medical credentialing is so important is that it helps to lower the overall risk of medical errors that can occur. Statistics show that each year, approximately 98,000 Americans end up dying as a result of various medical errors. This type of statistic has resulted in industry leaders to end up campaigning for more improved standards of competency, as well as exposure to disciplinary actions against healthcare workers. By credentialing healthcare providers, the overall risk of medical errors that would otherwise be caused by incompetent providers would end up getting reduced. Additionally, thanks to automation tools being employed by electronic credentialing, there will be no additional room for either fatigue or human error, both of which are typically associated with more manual credentialing.



One other great reason why medical credentialing is so important is that this type of process will prevent both hospitals and healthcare organizations from losing revenues. All medical offices find it necessary to partner together with insurance providers. Additionally, both healthcare professionals and physicians alike are always required to provide a list of verifications to these same insurance providers in order to be considered for any and all reimbursement expenses. Any failures by healthcare professionals to obtain all of the proper credentialing will end up resulting in insurance providers not providing reimbursement to medical offices that bill for the professionals. If a medical office allows a professional to perform any services before any credentialing is done, then the insurance provider will be able to backdate the actual reimbursement of the medical office in order to cover all of the services that are offered.



Another reason why medical credentialing is important is that it works to improve the overall reputation of health practitioners. Now that more and more patients are taking the time to conduct their own research in regards to their specific healthcare professional prior to visiting them. This makes it even more important for healthcare professionals to both take control and manage their own online reputations in order to ensure that they will be able to retain their clients. Perhaps one of the most important steps that they can take involving this is to undergo medical credentialing. This will ensure that they will be able to treat all patients, no matter what specific type of insurance plan they may have.


Why Is Credentialing Important? Thank you for visiting Quick Claimers Medical Billing blog, an El Paso based company that provides credentialing, medical billing, and many other services. If you are looking to further discuss if credentialing is right for your business, please contact us today for a consultation.