Credentialing In Health Care

Credentialing is the process utilized by employers, often hospitals or health maintenance organizations (HMO), to verify that a practitioner has the required education, training, and experience to practice in the state. State or local laws and rules often specify the types of credentials and verification processes, in which hospitals or another healthcare provider must address in credentialing a practitioner. This process of credentialing is typically done when a practitioner is first employed with a hospital or health maintenance organization and may be updated periodically. ("," 2103, para. 4) Until recently, the term credentialing was associated with frustration and discontent. This association of credentialing with frustration and discontent
(Bare, 2004, para. 1) The system, CAQH ProView is a system for self-reported provider data and was developed to help physicians, by providing a universal system of enrollment, credentialing, and recertifying credentialing to participating health care organizations. This process has shown to have a significant advantage over the previous methods of credentialing by reducing time and
This in turn was required by the hospitals or health maintenance organization so that they would be compensated for services rendered. To make matters worse, this process was required for each and every insurance provider that the hospital, health maintenance organization and or physician dealt with. Due to this lengthy and painful process, many hospitals, health maintenance organizations, and or physicians would only submit applications with the major insurance providers within their area of practice. Unfortunately, this would drive costs up for patience that were not covered by the insurance companies that the hospitals, HMOs, and physicians chose to be credentialed by. One can now see how the need for the development of such a universal credentialing process was well