What is credentialing? In the healthcare industry, hospitals, managed care organizations, medical schools, and large group practices are just a few entity types that perform credentialing to determine if the healthcare providers affiliated with them are competent, qualified, and legally registered to practice. Credentialing sounds complicated, but it isn’t. Yes, there are a lot of steps entailed. Some of those steps have been mandated by state and federal guidelines as well a

The stories never change. It doesn’t seem to matter whether it’s a medical services office in a hospital or a credentialing department for an insurer. The staff is working on overload. Why? There is an array of answers to that question. Many offices are still dependent on spreadsheets as opposed to a database. Other offices that have access to databases do not fully utilize them. Nor do they have the staff to manage them properly. Some offices use CVO’s that meet only a port

Over the past twenty years, I have witnessed and encountered some of the best, some of the worst, and some of the strangest credentialing programs. That’s why I enjoy helping organizations pull together a successful, streamline program that should almost run itself with the right tools and the right staff. But, first things first. To thrive the organization will need to develop a sound structure and foundation for credentialing. Here are six recommendations to make sure that

The credentialing profession is about consistency. Regulatory and accrediting agencies mandate a set of criteria. All we have to do is follow that criterion to the letter. Sounds simple, right? To the individual unfamiliar with that simplified criteria, yes. The first impression would be to follow the directions to create a successful program. However, those of us in the profession know that the process is anything but simple. Collecting and verifying data may be the easy par

ARCHITECTS first get a view of the land. Before they envision a building, they envision what would fit into that landscape. The architect then considers what occupies the surrounding space. It is then they start pulling it all together with drawings and photos and notes. That is typically how a credentialing or provider enrollment program should be designed. To build a successful credentialing or provider enrollment program, you need to know the lay of the land. You need to k

THE CANDY IS tempting. The costumes are fun. Fall has arrived with a bang as the brilliant fall colors trigger new ideas for the coming year. Celebrate. Get ready for the next year by planning now how to train your staff for optimum production and satisfaction. Happy Halloween from The Right Credentials Network! Your source for customized on-demand training for the credentialing professional! Dilsa S. Bailey, CPMSM Trainer and Consultant 678-744-4825 www.trcn-training.com www

IT WAS SUPPOSED to be a one week temporary assignment at a small hospital in Philadelphia. St. Josesph's Hospital had just merged with Girard Medical Center down the street and was officially known as North Philadelphia Health System. In the year 1991, I walked through those hospital doors without any notion of the turn my life was about to take. One week turned into another and another and another. Before I chose to move on, I had functioned in one role as a multi-function