5 Medical Credentialing Mistakes to Avoid

5 Medical Credentialing Mistakes to Avoid Annashae

5 Medical Credentialing Mistakes to Avoid

It’s a fact that healthcare credentialing is a necessary procedure for all practitioners, nurses, medical assistants and therapists.

As a rule of thumb, everyone involved in working with patients must undergo the process of validating their credentials.

Without proper credentialing processes in place, healthcare organizations risk committing errors that leave them vulnerable to lawsuits, fines, penalties and loss of business. That’s why taking the time to do it right is so important.

There are a number of credentialing procedural mistakes that can have a negative impact on your business. Here are five common ones to avoid:


Not Knowing Your State’s Regulations

States have different laws regarding credentialing, and it’s essential to know what your state requires. Every state has specific requirements for different sectors in the medical field. In addition, some states have reciprocal agreements, meaning that credentialing in State A is allowed in State B – but this is not the case across the board.

Understanding your state’s specific laws and regulations before starting the process can not only save time but ensure that you’re providing the required information.

Not Providing All of the Required Data

Providing all of the necessary information will speed up the process and save you time and effort in the long run. The credentialing process is time-consuming and depending on the organization it can take around three weeks to six months to complete. Each individual tasked with patient healthcare in a practice must go through the process. That means submitting educational qualifications, employment history, training, certificates, residency, licenses, and sometimes even CPR or RBT certifications are required.

Not Submitting Correct Information

Credentialing requires a large amount of data verification and data entry. If your credentialing team neglects to fill out parts of the application or submits incorrect information, they can cause reimbursement delays, denied claims, or even the hiring of unqualified individuals.

The information in the Council of Affordable Quality Healthcare’s (CAQH) database must be accurate, or it will delay the credentialing process. Studies show that 85% of applications have some type of information error, such as outdated, missing, or inaccurate information. The government holds entities responsible for employing excluded providers, even if the error was unintentional, so providing compliance training for staff can ensure that they clearly understand credentialing procedures.

Not Allowing Enough Time

As mentioned, credentialing can take up to a six months, so any unnecessary delays can cause problems. When credentialing staff isn’t given sufficient time or resources to complete the job, they can become overwhelmed and make mistakes. Your organization should allow adequate time and resources for credentialing – doing the job right should be prioritized over speed.

Not Checking the Status of the Application

It’s important to follow up as quickly as possible after submitting the application. This is an important step to confirm that the application is in process and that nothing is missing or incorrect. There have been reports of insurance firms failing to notify individuals about problems in their applications, further delaying an already lengthy procedure.

Contact Annashae Today to Learn More

At Annashae Healthcare Staffing and Consulting we’re dedicated to the placement of highly-skilled clinical practitioners in short and long-term positions. As a nationwide medical staffing and consulting firm, we provide a range of services that enable our candidates to quickly find the career opportunity that fits their needs. For information on how you can further your clinical career, including credentialing advice, CONTACT US today.