Provider Enrollment and Credentialing: What’s the Difference?
a man offering provider enrollment services
Hiring incompetent healthcare providers within your facility can cause several liabilities in malpractice suits. To ensure your facility doesn’t encounter this, enrollment and credentialing of your providers should be kept up to date and managed properly. If this doesn’t happen, your revenue cycle would be compromised. Plus, your facility may also be at risk of violating compliance.
Understanding the difference between these two terms is paramount to manage your enrollment and provider credentialing processes properly.
What is medical provider credentialing?
It’s the responsibility of healthcare providers to offer medical credentialing, which is a sequential process of acquiring a network between insurance organizations. People also call it getting on an insurance panel.
Often, medical credentialing is offered by an array of healthcare specialists like counselors, therapists, chiropractors, and more. Plus, many insurance companies have offered credentialing services to various health facilities since people who need healthcare know they can take their insurance to a facility that approves it.
What is medical provider enrollment?
It’s also referred to as payer enrollment. It arranges medical providers and places them onto Medicaid, Medicare, networks, and insurance plans, so the provider receives payments for the services offered to those patients. The providers enrolled with some of the best health plans are considered to be ‘in-network.’ Compared to out-of-network providers, patients receive more cost-saving services from in-network.
a man offering Medicaid provider enrollment services
Provider enrollment versus credentialing: What’s the difference?
Enrollment and credentialing both carry out similar tasks related to verifying the credentials of a provider – and credentialing is an important component of provider enrollment. Basically, credentialing is an umbrella term that includes everything needed to validate the qualifications of a provider – to participate in health plans, acquire hospital appointments, and/or attain employment.
Since credentialing is a condition of contracting with payers and granting, hiring hospital privileges, the work involved becomes quite laborious and repetitive as every entity (the payers, hospital(s), and the practice) must guarantee the provider has the right qualifications.
When you factor in the lack of standardization among health plans, there’s even more redundancy. Every player has their own individual credentialing requirements. So, to remain competitive, most of the providers enroll in multiple health plans. This translates to a lot of paperwork and time – in fact, 7-9 hours is the average time it takes for a credential provider with a single-payer per application.
This repetition goes on because providers would also have to renew their appointment with a hospital (often, once in a couple of years) and get done with revalidation with government payers and periodic re-credentialing with commercial insurance companies.
Premier Medical Credentialing’s medical credentialing service verifies the degrees and other credentials before a medical provider joins a hospital, surgery center, and an organization
Premier Medical Credentialing helps providers enroll into Medicare, Medicaid, and other payers for multiple hospitals in different states.
Contact us now for more information about our Medicaid provider enrollment service and Medicare payer enrollment service!