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Provider Credentialing - YouTube
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okay next up is provider credentialing
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so I just wanted to give a little
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background on provider credentialing so
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credentialing is a tedious verification
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process of a provider's education
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licensure certification and experience
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this is something that has to be done
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for your MDS your dio's your pas your
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physician's assistants and your nurse
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practitioners everybody has to be
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credentialed and a lot of information
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does need to be received from them with
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that said it isn't true that every
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different type of provider can be billed
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you know you can't you can't build them
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all for the same type of service there
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is often variation the variation is can
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be by state there can be some state
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regulations it can also be by carrier
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and it can relate to specific services
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so the credentialing process is quite
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lengthy it's it's if again if carrier
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credentialing is the most challenging
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this is really the second there are a
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lot of third parties out there that can
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help you with your provider
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credentialing but I would say if you're
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hiring a new clinician you want to start
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right off the bat you really want to
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start getting all the information you
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need from them and organizing it so that
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you can then send it out and start
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credentialing that provider
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why does credentialing matter well this
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is basically you know when a service is
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build it has to be under a rendering it
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has to be billed for a provider that has
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been quote-unquote credentialed which
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means that they have been connected and
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confirmed by your insurance carriers it
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used to be that we really had to set up
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and link each provider to each carrier
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it's gotten a little easier over the
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time mostly because there's so many
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third parties out there to help you but
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it is a very lengthy process and it can
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often take six months to a year to
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actually get a provider fully
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credentialed to the point where you can
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bill services for them it is true that
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services must be billed in the name
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an NPI or national provider identifying
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number of the rendering provider and the
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only exception to that would be when
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you've got different locum tenens and
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reciprocal billing arrangements there
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there can be some exceptions but most of
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the time we're going to want to be
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actually billing under that rendering
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provider and making sure that that
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rendering provider is quite properly
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credentialed with insurance carriers
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insurance carriers will not reimburse
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for any services performed by a non
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credential provider so you might ask you
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know if you hire a new provider how are
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we actually billing for them if they if
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they don't get fully credentialed for a
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long time well typically how it's being
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billed is that they're working alongside
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other clinic clinical staff so that they
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can the other clinical staff can sign
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off on that encounter okay so what are
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some provider information we need from
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the provider we need their state license
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or DEA number board certification number
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it's good to have their diploma just for
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confirmation and you may have to
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actually send it to a third party the
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educational commission for foreign
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medical graduates this would be of
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course if your provider was educated
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outside of the US any certificates of
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completion for medical training their
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national provider identification number
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there's their CV I I did it when I was
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doing credentialing myself I actually
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found that sort of interesting that they
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needed that but I have had providers
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questioned on various gaps in their CV
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so it they they are looked at very
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closely Hospital affiliations and
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privileges particularly if you're a
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practice that's working very closely
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with a hospital proof of continuing
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education CC EES of course the
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much-sought-after malpractice facesheet
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an explanation of any pending or settled
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malpractice cases during the last five
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years their CLI
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a certificate there w9 and their
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driver's license
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so a lot of information again that's why
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you know as soon as you you have
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somebody who has actually signed off
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that they're going to be working for
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your organization a lot of this
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information you can actually receive
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before they have begun seeing patients
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and started working what we suggest is
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that you create a spreadsheet that you
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use to track all this information of
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course the most important thing here is
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that that's read sheet should not be
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available it should not be available to
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people generally in the organization and
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I always kept mine locked so that only I
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could edit it because you don't want a
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number or anything to be changed
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accidentally and have any issues there
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it's it's very important to keep it
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up-to-date okay once the application
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process has become you want to record
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the names of the insurance names of the
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people that you're working with in the
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insurance carriers and the date the
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applications were completed keep track
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of any notes you can use the same
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spreadsheet to do it and remember that
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you might have to keep following up with
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them and we also do recommend that all
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it correspondences send via certified
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mail just just to make sure you don't
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want to lose anything along the way and
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you have some very important personal
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information of your providers that
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you're sending along
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okay and last but not least for provider
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credentialing just remember to follow up
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two weeks after your submission inquire
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with the carrier regarding the
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credentialing committee and their
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meeting scheduled because see there the
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credentialing committee has to meet to
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confirm any any providers so it's that's
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part of the reason why it is such a
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lengthy process and be it sure to obtain
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the confirmation of any follow-up
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submissions it is very common for two
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for the provider the carriers to come
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back and ask for more information our
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clarifications just make sure that you
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follow up on any obtain confirmation
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that it was received on any follow-up
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submissions okay and this is just more
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about what could be in your grid for
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tracking
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