What Is Credentialing?
Provider credentialing is a fundamental process in the healthcare industry, essential for verifying and assessing the qualifications, training, experience, and professional history of healthcare providers.
This rigorous procedure ensures that practitioners meet the high standards set by healthcare organizations, regulatory bodies, and health insurance companies. At its core, credentialing guarantees that healthcare professionals are competent and qualified to deliver safe and
effective care to patients.
Credentialing involves verifying active licenses, checking for malpractice suits, and ensuring no state or federal sanctions are in place. This comprehensive vetting process, akin to a background check, confirms that providers are both professionally educated and trained, as well as personally
in good standing, to their services in a healthcare setting.
For health plans, credentialing is not just a regulatory requirement, but a crucial step in building
a network of credible providers. This diligence helps maintain the integrity of the network and ensures that members are receiving care from reputable professionals.
How Certify Can Help?
At Certify, we specialize in simplifying the credentialing process through a technology-forward
approach. Our solutions make credentialing less burdensome, more transparent, and highly efficient for both healthcare providers and health plans. By leveraging direct integrations with primary source verification sites, our system automates much of the data collection and verification processes, significantly reducing the time required to complete credentialing.85% reduction in credentialing turn around times.
On average, our platform can process files 30% faster than traditional methods, enabling health plans to credential up to 17 providers per day compared to the industry average of 10. This efficiency is achieved through automated checks of licenses, malpractice history, and educational backgrounds, alongside integrations with the National Practitioner Data Bank (NPDB) and various licensure boards.