Medical credentialing

Medical credentialing

Nowadays many of the credentialing solutions techniques have been changed recently. One of the processes called Medical credentialing which particularly evaluates the medical practitioner’s credentials of a license, or a training or experience of an individual being checked if eligible for practice or to provide service at a Healthcare institute. Healthcare credentialing is being taken nowadays up to a new level in modern healthcare. Many new technologies have been introduced. Many medical organizations verify through the process of insurance credentialing to the providers credentialing in medical billing to ensure they have valid licenses and certification for the practice.

Many of the healthcare providers are being assessed of their license, training, and experience along with the competence and also check out the capability of providing service or procedures. This process is known as Medical Credentialing. Credentialing nowadays has seen the changes in the concept dramatically being in intervening millennia, the core structure of the procedure is still the same ensures that the doctors who practice in any city/state have all the required training and also the correct experience to safely practice medicine.


The medical credentialing solution is considered a critical component of practice being developed which can deliver the highest level of patient care along with the insurance reimbursement. Through the Healthcare credentialing process, the states and the insurance providers can determine which requirements are met by medical providers. Healthcare credentialing software has allowed permission to healthcare organizations and insurance companies which can manage all data and records of all the healthcare providers.  From a point of view of a patient, the credentialing process gives surety that they are well qualified and are under competing hands  Every medical healthcare provider should complete this assessment where they start new practices in any city or state. Privileging and the Medical credentialing consist of a few simple processes containing provider credentialing, enrollment of a provider, and the privileging.


Recredentialing, also known as re-enrollment and revalidation occurs periodically and requires a provider to repeat the credentialing process. Providers will receive a letter letting them know that they are up for re-credentialing. If they don’t complete this within the deadline, their credentialing are suspended until the process is completed and approved.

Credentialing and recredentialing of in-network providers are among the major segments of revenue cycle management of practice managers. The healthcare providers, hospitals, FQHCs are struggling with manual, time-consuming, and traditional medical credentialing methods. These processes are fragmented, error-prone, and far away from smart integrations such as CAQH Proview, Peer review, NPI Registry, CME credit scoring, and more. OSP can solve this challenge by offering custom healthcare solutions to automate your medical credentialing workflow in a centralized manner. In centralized credentialing, two or more than two healthcare facilities share the cost of credentialing providers saving the total cost required. Even the providers get credentialed once, making the process more hassle-free and increasing the goodwill between providers and administrators. We program the medical credentialing system as per your needs to eliminate credentialing a single provider in multiple systems while maintaining the efficiency and data integrity of credentialing to complete your provider credentialing checklist.

Provider data verification is a time-consuming task and errors cause more harm than help. It includes collecting required data from the physicians, developing the credentialing strategy, auditing the provided data for accuracy, validating the data and certificates, managing provider profiles, and following up with payers. OSP’s long-standing experience in healthcare automation allows streamlining the credentialing workflow process by automating multiple inbound processes such as provider data verification, task management, provider data monitoring, document expiration alerts, and attestation aging credentialing metrics, OIG monitoring, and more. We help you in better hospital management with medical credentialing tasks with real-time, intuitive dashboards to enhance productivity and eliminate the redundancy in the process. 

Managing providers data requires a robust data management system. Provider database management with optimum data security is challenging and expensive for many providers and clinics. OSP can help you successfully access all the provider data with CAQH Proview integration. The Council for Affordable Quality Healthcare (CAQH) is a non-profit association of health insurers that collects and maintains a database of provider credentialing data. Almost 1,000 health plans, hospitals, and providers groups use CAQH ProView to streamline healthcare credentialing, improve in-network provider directories, and speed claims processing and adjudication. OSP can tailor healthcare solutions for insurance credentialing to maintain a single source of provider data across all your systems. Whether you require to send provider information into your EHR/EMR or push data to or pull from CAQH, our healthcare integrations will solve your challenge using standard HL7 messaging protocols.

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