ALASKA PROVIDER NETWORK MANAGEMENT
Alaska Provider Network Integrated system solutions that allow disparate care facilities to share clinical data across the continuum of care.
ALASKA PROVIDER NETWORK SERVICES
Provider credentialing services are crucial processes to ensure that healthcare providers meet specific qualifications and standards before they can participate in the insurance company's network and receive reimbursements for their services. These services aim to verify the credentials and qualifications of healthcare professionals to maintain the quality of care provided to the insured members. Below is an overview of the steps involved in provider credentialing:
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Application Collection
We can help Healthcare providers interested in joining the insurance company's network submit detailed applications that include their personal information, education, training, work history, licenses, certifications, and malpractice insurance details.
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Primary Source Verification
We can conduct primary source verification on behalf of Insurance Companies to ensure the accuracy of the information provided by the healthcare providers. This involves directly contacting educational institutions, licensing boards, previous employers, and other relevant organizations to verify the credentials.
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License Verification
We can verify that the healthcare provider has a valid and current license to practice in the state(s) where they wish to offer their services.
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Certification and Training Verification
For certain specialties or services, providers may need specific certifications or training. We can verify that the providers have completed the required certifications and training programs.
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Work History Verification
We can perform checks on the provider's work history to assess their professional experience and ensure they have not been involved in any malpractice or disciplinary actions.
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Malpractice Insurance Coverage
Providers are required to have malpractice insurance. We can confirm that the provider has sufficient coverage to protect against potential liability claims.
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Credentialing Committee Review
Some insurance companies have credentialing committees comprising healthcare professionals who review the completed applications and verification reports to determine whether the providers meet the company's network standards.
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Contracting
After successful completion of the credentialing process, the insurance company can enter into a contract with the healthcare provider. This contract outlines the terms of participation, reimbursement rates, and other relevant details.
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Re-Credentialing and Ongoing Monitoring
Provider credentialing is not a one-time process. Insurance companies regularly re-credential providers to ensure their continued compliance with standards. Additionally, ongoing monitoring of providers may take place to address any changes in credentials or potential issues that arise after initial credentialing.
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Provider Directory Update
Once the providers are credentialed, the insurance company updates its provider directory to reflect the new additions to its network, making it accessible to its members.
Provider credentialing services are essential for maintaining a high standard of care within the insurance company's network and providing confidence to its members that they are receiving care from qualified and reputable healthcare professionals.
APN RESOURCE MANAGEMENT
Alaska Provider Network Integrated affordable staffing and benefit solutions.
