What is the physician credentialing?


Hospitals, physician offices, managed care insurance companies, and laboratories all credential physicians. Credentialing is the act of obtaining information about a doctor or medical provider to ensure their ability to practice medicine in their particular specialty.

There are several agencies that oversee the credentialing process. Utilization Review Accreditation Commission (URAC) is considered the leading organization that monitors the credentials and qualifications standards in health care. Medical have to go through the credentialing process before they are hired by health insurance companies. Physician credentialing, sometimes referred to as medical credentialing, will establish education, licensing, training, quality and overall moral standing provider of medical community.

identification process begins with medical doctor with information become the credentialing agency for review. Priorities are:

• Education – confirm the medical school and any post-graduate training

• Board Certification – specialty certification and training

• License – where a doctor keeps license

• Background Check – any criminal history is studied

• malpractice claims – check for any malpractice claims and / or award

• Malpractice Insurance – ensure appropriate levels of insurance available

• The Federation of State Medical Board review

• Rights -hospitals where physician practices

• Staff References

• Keep work detailing the history of

The information is collected and undergo a medical peer-review committee. These committees make recommendations on professionalism and stand made within the medical community. The committees will often assess the ethical conduct medical provider.

Insurance companies, including government-funded payers, will study medical credentials of your doctor before you take her or him in the group of participating providers. Medicare and Medicaid will not allow doctors who have not gone through the identification procedure to bill for services. Managed care organizations also have strict physician credentialing process before hand you can listen to and engage with the insurance company. Many private practice physician credentials also their physicians to ensure quality service delivery.

Publisher credentialing is the way to assure consumers that medical providers have been reviewed by their peers. It provides greater confidence and ensure that the provider is licensed and Board Certified and has not had a license or rights revoked in another state. It can not, however, determine the quality of care delivery by hand. Most credentials committees have policies that providers have to participate in regular changes credentials and reviews of preserving their current.

There are companies such medical consulting practice, specializing in providing credentials. The companies have consulted with health and / or provider practices to monitor and ensure that the credentials of doctors still current.


Leave a Reply

Your email address will not be published. Required fields are marked *

  • Partner links