Provider Onboarding -What is Credentialing?
TractManager’s cloud-based credentialing and provider enrollment software and professional services team help healthcare organizations streamline and accelerate all three components of provider credentialing—primary source verification (PSV), privileging, and payer enrollment.
“So, credentialing is funny, because it’s kind of misnomer. It’s an umbrella term. So when you think about credentialing, it means a couple of different things. First, it could be primary source verification – the process of validating the information that a provider has given you, to make sure they are who they said they are, and they’ve done what they said they’ve done. Credentialing also means provider enrollment – the process of basically taking that provider’s information, giving it to an insurance company, whether it be Medicare, Medicaid, or any of the commercial insurance companies, and making sure that those providers are added to what’s called the insurer or payers panel. Basically saying that, let’s say Medicare will accept that provider for reimbursement of services provided. So, credentialing can also mean provider enrollment. Credentialing can also mean privileging – the opportunity of once you’ve done your primary source verification and you’ve vetted out that Dr. Smith has done everything that they said they were going to do to grant privileges to actually see patients within that organization. So it’s not enough to just validate them, you have to make sure then that they’re granted privileges for specific procedures, within an organization.”
Scott Friesen, Provider Management Adviser