Provide an executive summary to your team on how to credential providers. You will need to...

Provide an executive summary to your team on how to credential providers. You will need to consider the following:

Type of provider being credentialed

Steps they will go thru to be credentialed

Educational background needed

Does this provider have an NPI number?

State the provider will work in

Is there a standard application?

Is an onsite visit needed; why or why not

Who gets credentialed (list at least 5 specialties)

Are all facilities credentialed?

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Expert Solution

Type of provider being credentialed&Educational background needed&Who gets credentialed

General definitions for the many different credentials of our health care team.

MD= A MD has a doctoral degree for physicians awarded by accredited medical schools. A MD works to maintain or restore human health through the study, diagnosis and treatment of disease or injury

MBBS or MBBCh = Bachelor of Medicine and Bachelor of Science.Professional degrees awarded in medicine and surgery by universities in foreign countries and are equivalent to an MD degree.

PhD = Doctor of Philosophy.This advanced academic degree is awarded for submitting a thesis or dissertation of original academic research for publication.

DNP = Doctor of Nursing Practice.A Doctor of Nursing Practice (DNP) can diagnose and treat a wide range of health problems and care for people with complex, chronic conditions – similar to a physician

Advanced practice providers (NP and PA) work under the supervision of a physician, yet independently, to provide some of the same care provided by physicians

Certified Nurse Practitioner (CNP)A certified nurse practitioner (CNP) is a registered nurse (RN) who has completed advanced education (a minimum of a master's degree) and training in the diagnosis and management of common medical conditions

Physician Assistant (PA)A PA is a licensed health care provider who can provide a broad range of health care services that are traditionally performed by a physician

Certified Nurse Midwife (CNM)Certified Nurse Midwives (CNMs) are registered nurses with specialized training in assisting pregnant women

(ref-https://www.centracare.com/providers/definitions-of-health-care-provider-credentials)

Steps they will go thru to be credentialed

Start early. Though most credentialing can be done within 90 days in many markets, give yourself at least 150 days. ...
Pay attention on work history,attestations, donot have any incomplete details
Stay current with Coalition for Affordable Quality Healthcare (CAQH) as most of the payers have adopted this certain programme
Link a provider's start date
Know your state's regulations.

(ref-http://www.physicianspractice.com/payers/five-steps-easy-physician-credentialing)

Does this provider have an NPI number?

NPIs will be assigned to health care providers who need to submit claims or conduct other transactions specified by HIPAA.

Is there a standard application?

There is a standard application for credentialising providers

Nightingale answered 1 year ago

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