Health Care Credential Management: How It’s Done

IN A NUTSHELL:

• Majority of credentialing conducted manually

• Length of time to complete process biggest issue

Written by Ayan Monpara, MD

Physician credentialing is the process of organizing and verifying a doctor’s professional records.

Health care facilities have a legal responsibility to verify a provider’s identity, education, work experience, malpractice history, and license verifications to protect patients from unqualified providers.

When a physician applies to practice within a health care facility, they are asked to complete an application and allow a credentialing entity to research their professional documents. For a doctor, the National Provider Identifier, licenses, certifications, diplomas, and professional references are all considered credentialing documents. The process of credentialing is to verify the accuracy and specific data in their documents.

The credentialing process also conducts what is known as Primary Source Verification. This is the process of requesting and receiving verification of the physician’s stated credentials from the university or other entity that issued the diploma or certificate.

Problems begin when there are inaccuracies and discrepancies between various records.

Health care credentialing is conducted in a variety of different ways across all sectors of the industry. There are benefits and disadvantages to each method, but the time it

takes to complete the process is a prevalent issue across the board.

READ MORE | Health Care Credentialing: Methods, Management, and Cost (.pdf)

Using Microsoft Excel takes the longest amount of time to credential a health care professional, followed by manual methods, and then by the use of internal software.

Using externally purchased commercial software has been shown to take the least amount of time. However, a majority of health care workers reported that they complete the credentialing process manually.

Regardless of how much time it takes, health care credentialing is imperative for the reputation of the facility and the quality of patient care.