Individual Provider Credentialing Services
As a patient, you would not want to compromise with your doctor’s qualifications. As a healthcare organization, you want to employ doctors who are well-qualified and best at what they do. Qualified providers with a good track record are crucial to any practice’s success.
Individual provider credentialing verifies a provider’s qualifications and background against the standards of patient care, so patients receive safe, quality care in healthcare organizations big or small.
The Need for Individual Provider Credentialing
Without credentialing, a provider is bound to face multiple challenges. Credentialing ensures a patient is being treated in safe hands.
Safe, Quality Patient Care
Providers who meet regulatory standards help patients receive safe, effective, and high-quality care.
Regulatory Compliance
Meeting the standards set by regulatory bodies keeps your organization aligned with what is required of it.
Minimized Audit Risk
A verified, well-documented provider network reduces the risks that come with audits.
TrueCareCost Revenue Cycle Management’s Credentialing Process
As a leader in healthcare billing and coding, TrueCareCost Revenue Cycle Management provides individual provider credentialing. Our rigorous process ensures every provider meets the necessary standards of quality, compliance, and safety.
Application Submission
Doctors, nurses and specialists fill out an application covering education, professional background, work history, specialities and certifications.
Verification of Information
An important step that moves the process ahead. Licenses, certifications, training, work history and more are verified, as listed below.
Background Checks
We check for past criminal activity, convictions, and ongoing legal issues that can affect provider credentialing.
Review and Evaluation
A credentialing committee reviews qualifications, background and risk areas such as malpractice history, disciplinary actions, and clinical performance.
Approval and Enrollment
Approved providers are offered a contract outlining participation terms and reimbursement rates, then added to the TrueCareCost Revenue Cycle Management provider network.
Ongoing Recredentialing
We re-credential regularly and monitor changes in credentials, licensure, claims history and clinical performance. Red flags may lead to further action.
If any discrepancies occur, a provider may be asked for additional information or clarification before approval.
What We Verify
The following documentation is verified during the verification step of the credentialing process.
Licensure verification of state and national licenses. Board certification through accredited boards and professional organizations. Education and training, including medical school, residency, fellowships and additional training programs. Work history and references from previous employers. Malpractice, claims history, lawsuits and disciplinary action history. Drug Enforcement Administration (DEA) and controlled substances use history.
Compliant with Regulatory Standards
TrueCareCost Revenue Cycle Management’s credentialing process complies with organizations including the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA), among others.
We undergo external audits for compliance with regulatory standards for provider credentialing and network management.
A Network You Can Trust
Our structured credentialing process ensures that all healthcare providers in our network are qualified, licensed and capable of delivering high-quality care to patients.
Why Outsource Individual Provider Credentialing to TrueCareCost Revenue Cycle Management?
TrueCareCost Revenue Cycle Management is a leading medical billing and service provider in the country. Practices across the country choose us for individual provider credentialing because we do not compromise on compliance.
Keep Your Providers Verified and Your Practice Compliant
A network of well-qualified, compliant providers protects the integrity of your organization. By thoroughly verifying qualifications, backgrounds, and ongoing performance, TrueCareCost Revenue Cycle Management helps you save time, reduce errors, and focus on delivering exceptional patient care.