Insurance companies, hospitals and medical provider offices all use the process of physician credentialing to ensure that the staff they hire are in good standing with their professional organizations. These companies should consider the credentialing process as a good way to instill confidence in their patients that the providers have passed a rigorous process that ensures medical licenses and board certifications are current.

Credentialing Guidelines

Physician credentialing is the process of ensuring that doctors are qualified and competent, and have met certain standards as defined by physician reviewing organizations. The process is based on objective peer review criteria, as well as established professional practice. There are certain areas that are reviewed in the process of this credentialing.

•Doctor's medical license, board certifications, education and training are areas that are reviewed to make sure they are current and valid

•Malpractice charges or any charges or claims of clinical incompetence of lack of judgment

•Practicing privileges in fields of specialty

•Investigation of physician’s character by peers and in the community where the physician practices

Overall, the medical credentialing process relates to patient care and physician performance, and how they measure against usual and customary standards of care. The Utilization Review Accreditation Commission is the gold-standard of credentialing oversight in healthcare. There are also companies that gather and provide information required for medical and physician credentialing, and also manage updates and administration of the total process.

Importance of Physician Credentialing

There is no guarantee that a doctor who has passed the credential review process will never have an unhappy patient or negative healthcare outcome. The review is a snapshot in time that states that the doctor has met all the required guidelines to practice in his or her specialty, and is well-respected by peers. The credentialing relates to quality patient care, therefore should be utilized by medical organizations seeking to hire doctors and consumers seeking to obtain care from them.

Insurance companies require credentialing in order for physicians and other ancillary providers to participate in their network of care givers. Medicare and Medicaid also use a credentialing process for providers who wish to be reimbursed by these insurance companies. Providers must keep their credentialing status current, and submit updates periodically.

The task of credentialing physicians is time-consuming task, especially for large medical practices that have limited staff. Independent companies perform medical credentialing and perform the intensive follow-up to ensure that all pertinent information maintains current. Information collected credentialing is personal, and the credentialing process should be performed with the highest degree of confidentiality and with appropriate information safeguards.