As a medical professional, medical credentialing is most likely a topic you hear of often. Medical Credentialing is a method used to assess the qualifications and practice history of a doctor. This systematic, in-depth, and time-consuming process also includes the process of becoming associated with insurance companies (also known as provider enrollment) so that you […]
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Two Types of NPI Many healthcare providers don’t realize that there are actually two types of NPIs. The CMS (Centers for Medicare and Medicaid Services) describes them like this. Type 1: Healthcare providers who are individuals, including physicians, dentists, and all sole proprietors. An individual is eligible for only one NPI. Type 2: Healthcare providers who
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The Council for Affordable Quality Healthcare (CAQH) is a nonprofit alliance of health plans and trade associations designed to simplify healthcare administration through industry initiatives, such as the Universal Provider Datasource. What is CAQH’s UPD and how will it simplify administrative processes for me? The Council for Affordable Quality Healthcare’s Universal Provider Datasource (UPD) is
Credentialing and enrollment are critical business processes within the hospital, physician and allied health provider revenue cycle. When not managed properly, they can, and will, negatively impact a healthcare organization’s revenue. With regulatory requirements becoming more and more complex, incorrectly or poorly managed credentialing and enrollment processes also put hospitals at risk for compliance violations
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THE ANCIENT PRACTICE OF CREDENTIALING Medical credentialing dates back to Persia in 1000 BC, as outlined by the Cult of Zoroaster. In ancient Persia, to qualify for licensure, a physician had to treat three heretics — if they lived, that qualified the physician to practice medicine for the rest of their natural life. While credentialing has
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