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7 Examples of What Could Happen Without Medical Credentialing

MedTrainer

Inability to receive reimbursement: Insurance companies and government payers require medical credentialing to authenticate a provider’s qualifications to practice. Without verifying qualifications, healthcare organizations won’t receive reimbursement for patient care services from insurance or government payers.

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Aetna Provider Enrollment: What To Expect

MedTrainer

Download Now Aetna Provider Enrollment Guidelines Aetna requires that all providers meet standard credentialing criteria to become a healthcare professional in its network. Download our guide – Tools to Conquer Provider Enrollment – for valuable tips on speeding up the time from credentialing to enrollment approval.

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What Are Reportable Events in Healthcare?

MedTrainer

To underline the significance and complexity of this system, we will explore what are reportable events in healthcare, the regulatory requirements that govern them, the types of reportable events, and the importance of proper reporting. Each state has its own set of laws and regulations dictating what must be reported and when.

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The Importance of Primary Source Verification for Practitioner Credentials

Verisys

An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. The policy issuer for malpractice insurance verifies insurance coverage. The Primary Source Organizations. Unpublished Data.

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Privileges and Credentialing Aren’t the Same

MedTrainer

Additionally, the credentialing specialist may request a record of any pending and past medical malpractice cases and disciplinary actions from the appropriate authority. Download Now What are Provider Privileges? Whether it’s government regulation or healthcare facility requirements is a matter.

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The Importance of Primary Source Verification for Practitioner Credentials

Verisys

An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. The policy issuer for malpractice insurance verifies insurance coverage. Government and Non-Government Sources. Criminal history.

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How To Prepare for an OIG Inspection

MedTrainer

Download “Compliance Reports You Can’t Live Without” for OIG reporting templates and tips. While learning of an inspection can cause alarm, oftentimes it’s a routine occurrence required by the federal government to ensure the overall quality and delivery of healthcare services. What Prompts an OIG Inspection?

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