6 Steps for Streamlining Physician Credentialing Processes
                     6 Steps for 
Streamlining 
Physician 
Credentialing 
Processes
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Introduction:
The prime motive of every physician is to provide un-compromised medical 
services to his/her patients. 2
It is based on the quality of the services that patients decide whether to 
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visit the same physician or change for good.
Introduction:
• Only a well-trained and experienced 
physician can render high-quality services 
and to attest his/her merit, provider 
credentialing is necessary. 
• Physician credentialing is a process through 
which Providers are validated for their 
educational qualification, certification, work 
history, and conduct. 
• It is done every time a medical practitioner 
joins a hospital. Also, re-credentialing is 
performed each year. 
• There is yet another process called 
privileging through which a physician is 
authorized to render a certain scope of 
clinical service based on his/her 3
credentials. 
• All these processes are complicated wawwn.edca reindia.com
consume too much time, affecting the 
normal functioning of medical billing 
companies and their revenue cycle. 
Accuracy is 
Key
•  It is highly essential that the data 
entered in a medical billing 
company’s provider credentialing 
system matches the data entered 
into the Payer’s credentialing 
system. 
• If there is a mismatch, the revenue 
will eventually get affected. 
• Therefore, do a thorough check on 
the Provider’s background 
information before entering into the 
physician credentialing system. 
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Use Cloud-based 
Platform
• Documenting Provider information is 
essential and real-time data is the best bet. 
• To enable it, medical billing companies
 should integrate their systems with a 
cloud-based platform for efficient provider 
credentialing. 
• This way, documenting, accessing, and 
sharing data will be easier.
•  Constant reviewing and updating data into 
the cloud systems is crucial to avoid errors 
during submission.
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Enhance Operations 
through Automations
• As physician credentialing is a time-
consuming process, traditional data 
systems will only delay it further. 
• Using high-end automated systems 
can really enhance the process. 
• These systems automate critical 
credentialing tasks to send 
reminders and requests for timely 
submission of applications or 
reviewing of red flags.
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Follow-up
• It is a good practice to keep tabs on 
insurance companies once the provider 
credentialing process starts.
• By staying in the loop and following up 
on regular time intervals will let you 
know the status of the application as 
well as hasten the process. 
• Meeting every Payer’s individual set of 
rules and regulations is essential.
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Tracking & Reporting
• Implementing best practices will 
improve the physician credentialing 
process. One of them is tracking and 
reporting. 
• Keeping a track on the provider 
enrollment days, department & 
provider processing times, and 
multiple payers’ rules set is essential. 
• The staff must submit weekly or 
monthly reports with the tracked data 
to the higher authorities for review. 
• Necessary steps should be taken if 
there are areas of improvement. 8
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Outsourcing
• Most medical billing companies are 
preoccupied with major medical billing 
functions, overlooking provider 
credentialing. Therefore, they lack the 
aforementioned streamlining properties. 
• In that case, outsourcing would be the 
best bet. 
Offshore medical billing companies are 
equipped with high-end data systems and 
cloud-based software to enhance the 
physician credentialing process. 
• They also come with experienced 
professionals who are adept in rendering 
error-free credentialing. 
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• Last but not least, they ensure faster 
turn-around times and better revwewwn.eucareein dia.com
generation at low costs.
About e-care India
 If you are on the lookout for a good offshore 
medical billing company, then choose e-care 
India. 
 This experienced vendor has been serving 
exceptional medical billing services including 
quality provider credentialing services for 
more than 18 years. 
 It prepares, maintains, and monitors Managed 
Care summaries. 
 E-care resolves enrollment issues and track 
Managed Care contracts more effectively than 
the other leading offshore companies in the 10
industry. www.ecareindia.com
 To know more about e-care and its services, log 
on to www.ecareindia.com.
Contact Us:
Phone:
813-666-0028
Email:
[email protected]
Website:
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