Why Is Provider Credentialing Necessary for Patients?

Patients always trust that their healthcare practitioners have the appropriate qualifications and skills to offer safe and effective care. However, with so many unlicensed doctors on the streets, how can patients be certain that their healthcare provider is qualified and competent? 

This is when provider credentialing comes into play. It is critical to patient safety, quality care, regulatory compliance, and insurance coverage. We’ll talk about the significance of provider credentialing for patients and how it can assist them make educated healthcare decisions. 

Provides Quality Care

Credentialing of physicians is required to ensure that patients receive quality care from competent and qualified healthcare providers. The collection of provider information also validates a healthcare provider’s education, training, licensure, and other credentials, providing patients confidence in their provider’s skills and experience. 

Assume you’re looking for a new primary care physician and you find one who is licensed and credentialed by your insurance company. This indicates they were subjected to a thorough screening procedure and met particular criteria in order to get accredited. As a result, you’ll have the assurance that you’re receiving high-quality care. 

Furthermore, if you require the services of a specialist, your insurance company may only cover the cost of care provided by an accredited physician, ensuring that your concerns are addressed by a qualified professional. 

Provider credentialing assists in identifying healthcare practitioners who have a history of malpractice, misconduct, or disciplinary action, preventing them from continuing to deliver subpar care that could damage patients. 

Assume a patient seeking treatment from a new dentist discovers that the doctor has been disciplined due to a history of malpractice. However, the patient chooses to disregard this information and continue with the treatment. Their decision may result in a negative outcome or bring them harm. However, if the patient had checked the dentist’s credentials, they could have avoided the risk of harm or poor outcomes associated with such a provider. 

Insurance coverage is provided.

To be eligible for coverage under many insurance policies, healthcare practitioners must be certified. This stipulation shields patients from having to pay the full cost of healthcare treatments. 

For instance, a patient’s health insurance policy may only cover services offered by credentialed physicians. If they receive care from a non-credentialed doctor, they may be required to pay the whole cost of the service. This can be costly, discouraging many individuals from obtaining critical medical care in the future. 

To access provider information and certifications, insurance firms employ free credentialing tools such as CAQH re-attestation. Providers are expected to update their credentials once every quarter (every 120 days), attesting that their information is current and correct. 

Maintains Regulatory Compliance

Before practicing medicine, regulatory authorities such as state medical boards frequently require healthcare providers to be certified. 

Consider a patient seeking medical attention from an unlicensed and uncredentialed dentist. The physician may be ineligible to practice dentistry in that state and may lack the necessary credentials, abilities, and expertise to offer quality dental care. In the long run, this can lead to major tooth health concerns. 

Keeping Patients Safe from Poor Care

Patients can ensure their physicians have the appropriate qualifications, abilities, and expertise to deliver safe and effective care by examining a healthcare provider’s credentials. This not only safeguards the patient’s health but also provides them with peace of mind. 

Furthermore, healthcare providers can use tools like CredyApp to streamline the credentialing process aka verification of provider qualifications. This all-in-one tool enables providers to easily manage their credentials while remaining compliant with regulatory requirements and providing quality care to their patients.