What Is Healthcare Credentialing?

Healthcare Credentialing is a system used by various organizations and agencies to ensure that their healthcare practitioners meet all of the necessary requirements and are appropriately qualified. The credentials may vary depending on the specified area of the practitioner. For example, an X-ray technician may have different credentialing forms than an osteopathic physician.

Function

• Healthcare Credentialing can be conducted by an insurance provider network, healthcare facility or association. The mission of the process is to assess the subject's experience and legitimacy. To do this, they look into things like their background; what institution they graduated from, where they conducted their internship, residency and fellowship. Board Certifications and State Medical License(s) are also examined to evaluate the practice, training, skill level and capacity to administer specific services or carryout specific procedures.

Significance

• Additional investigation into individuals' professional references, liability claims history, privileges, associated memberships and status with the Department of Health and Human Services may also be required. While some healthcare establishments perform their own credentialing or employ people on their staff to do so, others do it externally. This means that they go through a credentialing company or specialist.

Features

• Customized Credentialing Services (CCS) and Kroll Background Screening Group, Inc., (KBSG) are companies that are hired in the credentialing process; to look into an individual and their background and make sure that they meet all of the standards and criteria. In addition to the above, they may also check a candidate's standing in the National Practitioner Data Bank (NPDB), their American Medical Association (AMA) profile and, if they are graduates of a foreign medical school, an ECFMG Status will be examined (Educational Commission for Foreign Medical Graduates).

Identification

• The Utilization Review Accreditation Commission (URAC) is regarded as the foremost organization that oversees the credentialing and qualification standards in the healthcare industry. Along those lines, HCPro, Inc. specializes in giving information that's relevant to healthcare compliance, credentialing, regulation and overall industry administration.
  States like Illinois abide by The Health Care Professional Credentials Data Collection Act; which requires that all hospitals, healthcare facilities and policies must utilize credentialing forms.These forms are typically mandated by the specific state where the facility or practitioner is located. The forms also oversee the process of re-credentialing, and must maintain current records of every physician. The requirements are broken down into the practitioners' areas of practice. You can view the forms and date required on the IDPH website (idph.state.il.us).

Time Frame

• Healthcare Credentialing is generally conducted prior to employment, during their preliminary application and interview. Their credentialing is monitored and checked from then on in set intervals. The sites linked in the Resources section below contain additional information about healthcare credentialing and some of the companies that are used to verify it.