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The Importance of Physician Credentialing

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Especially with something as critical to life and its safety as healthcare, the credibility of the attending physician is a foremost consideration.  That is the major reason for all States adopting Licensing processes.  This is also the reason why Payers implement their own verification before contracting with Providers through the process of physician credentialing.


Physician credentialing verifies all the relevant professional information provided by doctors including education, training, licensure and certification. Physician credentialing also assesses whether the physician abides by standard codes of conduct.  This type of rigorous double checking by the Payers is meant to ensure competence and legitimacy among healthcare providers who are contracted with them. 


Why is this important for patients? Because, those in need of medical care must be reassured that they are in good hands and have implicit trust in the Physician’s decisions. Why is this important for doctors and other medical providers? Below are some of the advantages of medical credentialing.


Benefits of Physician Credentialing For Providers:


Physician credentialing is now standard procedure for insurance companies. It is the only way to remain at par with other medical service providers in that geographical area whose credentials have already been checked.


Physician credentialing also ensures that providers are not shortchanged.   Gaining competence through education, training and other venues for supplementary learning do have their costs.  Physicians can command professional fees commensurate to their experience and skill level if their credentials have been verified by more than one Payer.


Physician credentialing also boosts a physician’s practice.  Patients who demand the best possible care will always look for trustworthy doctors and medical specialists. The HMO concept relies heavily on the Credentialing process to guide its members to the best possible Provider in that area.  As with every other product and service, reliability in healthcare is what determines client satisfaction and ultimately success.  Credentialed physicians are preferred by more patients and also payers.  Patient’s out-of-pocket expenses are also significantly lower if the Physician is credentialed by their payer.

Fraud, after all is not uncommon. The Federal government has been going after different types of fraud-related crimes in healthcare and has won or negotiated roughly $2.4 billion in judgments and settlements in 2011. Physician credentialing deters dishonesty in medical practice so it has a very positive impact on the industry as a whole. 


Through thorough background checking, Physician Credentialing guarantees that only qualified medical professionals who meet a certain standard attend to patients who are members of a payer’s plan.   Patients are reassured that their doctors, nurses and hospitals meet the industry standards for quality control. Quite simply, Physician Credentialing improves the quality of medical services in the United States.


How To Get a Physician Credentialed?


There are companies which specialize in physician credentialing. If you are a medical professional who wish to be a part of a network of credentialed healthcare providers, be sure to choose a company which meets the National Committee for Quality Assurance (NCQA) standards for health plans.


Registration is easy and can be done online. For as long as the physician can provide the data required and agree for the information to be scrutinized, the Physician Credentialing process can begin immediately. Soon enough, your medical providers can reap the benefits of being  verified, competent and trustworthy healthcare professionals.


For more information contact Niruka at 813-890-8004 x 7130 or email at [email protected]  You can also visit our website for more information.


About MGSI:

MGSI, LLC (MGSI), is rated among the top 10% of RCM companies nationwide. MGSI offers unique integrated solutions combining practice management software, physician billing, radiology billing, medical billing services, electronic health records, mobile charge capture and medical document management. Operating since the early 1990’s, MGSI has consistently been able to accelerate the claims process and dramatically reduce the time it takes to bill and collect a practice’s receivables.



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  • Posted On July 30, 2012
  • Published articles 10

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