Credentialing is a complex, multi-step process, but the way we document approvals doesn’t have to be. When signatures pile up unnecessarily or processes vary from one file to the next, the approval pathway becomes unclear and inefficient. Streamlining how we document credentialing decisions isn’t just a matter of preference—it’s a necessary step toward greater clarity,
Delegated credentialing is more than an operational efficiency—it’s a strategic approach that benefits healthcare organizations, providers, and payers alike. By shifting responsibility for the credentialing process to trusted organizations, payers streamline workflows while maintaining oversight through rigorous standards. For Provider Lifecycle Professionals (PLPs), delegated credentialing represents an opportunity to demonstrate their expertise while enhancing the
For years, TMG has been a thought leader in the conversation surrounding the integration of provider enrollment and credentialing. Recognizing the inherent overlap between these functions, TMG has consistently highlighted the potential for greater efficiency, improved workflows, and enhanced accuracy through their alignment. While traditionally managed as separate processes, both provider enrollment and credentialing aim
As value-based care (VBC) continues to reshape healthcare, Medical Services Professionals (MSPs) play a pivotal role in ensuring that practitioners are both credentialed and enrolled effectively. These interconnected processes are foundational to participating in alternative payment models (APMs), where reimbursement hinges on delivering high-quality, coordinated, and cost-efficient care. How Credentialing and Enrollment Drive Success in
Trust forms the foundation of healthcare. When patients enter a medical facility, they’re placing their well-being, and sometimes their lives, in the hands of professionals they may have never met before. They trust that these professionals are skilled, licensed, and competent. In this complex environment, credentialing—verifying and vetting healthcare practitioners’ qualifications—plays a critical role in
Many factors can impact processing times for medical staff applications at initial appointment and reappointment, including the use of a CVO, whether processes are automated, and the complexity of an applicant’s history. TMG’s infographic pinpoints 7 factors that influence processing times and 3 ways that ProVISIONary Staffing can help reduce time to completion: You can
Delegated credentialing can feel intimidating to both new and seasoned MSPs in managed care, hospital, or CVO environments. But the intimidation is replaced with confidence once you understand the foundations of the delegated credentialing process. Here are the six steps necessary for successful delegated credentialing: Facility contract: The group or facility must have an existing
When I was a newbie, I learned a central lesson about credentialing: that to ensure compliance with the standards, the primary source verification documents I obtained for a practitioner were for my facility only, and peer review information was confidential. That changed when shared services agreements began to take hold. Over the years, four trends
Medical Service Professionals often have Type A personalities. We’re highly organized and proactive – and at times impatient and a bit anxious. It’s understandable that the possibility of losing control over our credentialing process can trigger negative reactions. After all, each hospital and health plan has its own application, its own credentialing process, and its
In August and September, Team Med Global’s Donna Goestenkors, CPMSM®, EMSP, and Rachelle Silva, BS, CPCS®, CPMSM®, joined forces with symplr to present “Off the Hook: Reining in Telemedicine Challenges.” Given that COVID-19 has led to an exponential increase in the use of telemedicine around the U.S., it’s no surprise that the more than 1,000
Hospital credentialing policies outline the application and privileging requirements and criteria and procedures. Credentialing processes explain how information is gathered to provide information for review and decision making by department chairs, committees, and the governing body. The five best practices listed below - claims history, professional references, performance evaluations, onboarding, and internet and social media
