Why physician credentialing is important?

Posted by Ecareindia on June 24th, 2011

As a physician, it is essential for you to be credentialed and be in par with several prominent insurance carriers. You have to add this on top of your task list to improve your practice performance and serve your patients in a better way. Just like taking up professional licenses or buying a new machine for clinical procedures, getting credentialed is also an essential requisite to run a smooth practice with minimal risks. There are companies that provide physician credentialing services. You can save time and reduce the paper work by outsourcing the work to them.

Let us discuss the major benefits of physician credentialing:

  • Better payment: Insurance carriers pay better to the physicians who are in par with the insurance. In a long run, credentialed physicians benefit a lot and will not be over burdened with the need to collect more money from the patients. Patients who get treated by these physicians simultaneously benefit by getting maximum payment.                                   


  • Serve more patients: Credentialed physicians are considered as reliable providers and are listed in the ‘preferred physicians group’ from which patients usually select their physicians in order to get maximum benefits and avoid ‘out of the pocket expenses’. Therefore, credentialed physicians get more patients when compared to non-credentialed.
  • Improved quality in healthcare:  Healthcare frauds are becoming common in US these days involving a huge network of doctors, nurses and healthcare professionals.  Since physician credentialing involves complete background check on providers’ educational qualifications, professional licenses, experience, fellowship programs, and residence, it helps in controlling the healthcare fraud-related crimes and ensures that only qualified physicians deliver services to patients and thereby improving the quality of healthcare in US


  • Liberty to choose the fee plan: By being par with the insurance carriers, physicians can choose the best fee plan that will be profitable to them. Physicians can either get fee per service or take up the capitation fee model based on the average number of patients served per month with in the network of insurance carriers.


  • Access to the fee schedule: The exact fee schedule for different medical procedures and services are accessible to the Physicians who are in par with the insurance carriers. This fee schedule will determine the maximum reimbursement limit for different services and will help the physicians in sending the claims accordingly.


  • Positive Marketing:  A thorough physician credentialing plan can provide a positive marketing benefit to a network provider. Many MCO’s attract large number of members through their cost-effective plans.  By credentialing to these MCO’s the health care professional has the best option of being chosen by millions of members subscribed to these plans. Physician credentialing and Managed Care definitely share a strong relationship through which both the physician and members are benefited.


About the Author:
Tanya Gill is the Public Relations Manager for ecare India based in Chennai, India. She has wide knowledge and experience in the medical industry. ecare India is a leading medical billing company offering end-end medical billing services and is backed by extensive domain expertise, latest technology and dynamic compliance norms. ecare is HIPAA compliant and is the first Indian medical billing company to get ISO 27001: 2005 certified for information security management. ecare is also ISO 9001:2008 certified for quality management. By providing outsourced medical billing services, ecare makes it feasible.

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Joined: June 20th, 2011
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