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Why Payers Should Care About Provider Credentialing

Payers within the healthcare network play a critical role when it comes to reimbursing providers for services they administer and ensuring the safety of patients who are seeking care. At Signature Performance, we know that problems can quickly arise when there are inaccuracies or missing information within provider credentialing documents.

What is Provider Credentialing?

Provider credentialing is the process of organizing and authenticating a doctor’s professional and educational records. A few of the documents required during the credentialing process include professional licenses, certifications, and references. The detailed credentialing process can be daunting for providers, especially if the providers are contracted with multiple insurance companies. However, in order to build a consistent patient base, a healthcare provider should consider being credentialed with a number of payers.

Who are Payers?

A payer, or sometimes payor, is a company that pays for an administered medical service. An insurance company is the most common type of payer. A payer is responsible for processing patient eligibility, enrollment, claims, and payment. The Centers for Medicare and Medicaid Services (CMS) is one of the largest, and most respected, healthcare payers in the United States.

Why Payers Care About Provider Credentialing

The process of provider credentialing has a variety of purposes, but most importantly it is how providers receive payment for care that was administered to the patients they treated. If providers are not credentialed properly within a specific payer network, claims made to the payer can be denied or severely delayed. This delay or denial often leads to frustration for everyone involved in this important administrative function.

Most payers have a time limit as to when a claim can be filed, so providers who are not properly credentialed and continue to file claims can see significant monetary losses that may not be recovered.

The role of the payer during the credentialing process also ensures that the provider who has applied has provided current records of proper training and certification. Proper credentialing approval allows qualified providers to be available for more patients.

How Signature Improves Administrative Services

At Signature Performance, it’s our mission to improve efficiency within the healthcare administrative service industry. Our team has unmatched experience when it comes to being proactive in identifying and preventing recurring issues that interrupt critical revenue procedures that affect patients, providers and patients.

Our experience with the payer and provider side of the business allows our dedicated team the opportunity to evaluate industry issues holistically from both perspectives, eliminate any static within communication efforts and create custom solutions that get to the core of the problem. Getting to the core of the problem and solving it builds trust and credibility thereby strengthening the administrative network necessary to support great healthcare in the United States. We make it a priority to improve the client experience (CX) by eliminating expensive hurdles and improving compliance demands.

To learn more about Signature Performance and our mission of reducing healthcare administration costs, contact our team today!


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