Credentials Required — Again

October 12, 2010 at 7:36 pm Leave a comment

BACKGROUND NOTE: The preceding post highlighted some myths about vendor credentialing that surfaced at Vendormate’s recent vendor council forums.   At one of the forums, Dr. Thomas Zweng, CMO of Presbyterian Healthcare in Charlotte, NC,  shared with the vendors why he feels so strongly about the importance of vendor participation in vendor credentialing programs.   After he had finished, he stayed to answer their questions.

The group acknowledged the requirements hospitals faced, but they still challenged the hospital-by-hospital credentialing approach.

Dr. Zweng responded with his own experience as a physician dealing with hospitals and insurance companies.   Every two years, physicians have to complete extensive paperwork for each insurance company so that they are accepted as a qualified, reimbursable provider.  While the physicians may have spent  years successfully practicing medicine and working with that insurance company, they still have to re-apply.

And while each insurance company asks for essentially the same information, there is no reciprocity among carriers.   The paperwork has to be filed separately for Humana, Cigna, UnitedHealth, WellPoint, Aetna and any other carrier.

Separately too, the hospitals require reapplication for clinical privileges.

While all of these organizations share many of the same requirements, some are different.   And the internal processes and acceptable criteria are different as well.   Until all medical service providers operate in the exact same ways and with the exact same standards, reciprocity is impractical, if not impossible.


Entry filed under: vendor credentials.

Myths About Vendor Credentialing Vendor Credentialing Don’ts

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