- Numerous Legalities To Take Into Account – Requirements of the credentialing process vary from one accrediting entity to another and also from state to state. Keeping track of exactly what needs to be collected and submitted and in what format can be baffling, to say the very least. It is an excellent idea to enlist the services of a third-party vendor that can handle all your credentialing activities for you.
- Acquiring Peer References Can Be Next To Impossible – Peer references are an integral part of the credentialing process. These vital pieces of documentation are quite difficult to attain owing to the packed schedules of practicing physicians whose references you are seeking. Ensuring that you have completed all the requirements before approaching the peer physicians so that they are not bogged down by any additional administrative work other than just writing the review, is an excellent way to avoid disgruntling them and getting your job done quickly.
- Documenting Lengthy Professional Histories Can Be Tedious – Tracking a senior physician’s history as part of the credentialing process can be quite cumbersome. Some offices where such physicians have worked in the past have long since been closed, adding to the complexity of the verification process.
- Maintaining Recency – Mandatory re-evaluation every few years, as per the laws of the state, makes credentialing a cyclical process that needs to be revisited periodically. As a result, it is necessary to maintain records for all the checks conducted in the prior years to facilitate future verifications.
4 Challenges That Make Physician Credentialing A Tough Task
10th, Feb 2023
Reviews & Testimonials
"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans. Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline. We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."
NANCY GAREAUCEO of Ultimate Health Plans