Credentialing

The credentialing process is used to evaluate and validate the practice history and qualifications of a healthcare provider. Credentialing plays a critical role in protecting patients and giving them access to quality healthcare. 

Healthcare providers must meet credentialing criteria in order to become a provider at a certain network or hospital. Professional criteria that may be evaluated during the credentialing or re-credentialing process may include the following: 

    • Verification of education and training
    • Verification of licensure with appropriate licensing agency
    • Verification of clinical privileges
    • Board certification or certification eligibility
    • Eligibility to participate in Medicare or Medicaid programs
    • Professional liability insurance
    • Review of work history
    • Review of malpractice claims history

Your professional credentials are vital to your career. Credentialing issues could affect your ability to practice your profession. Jones Law Group works diligently to resolve credentialing issues and prevent the harsh consequences that could result.  Our attorneyshave an in-depth understanding of the laws and regulations pertaining to the rights of healthcare professionals in Ohio and have represented hospitals, clinics, and healthcare providers in credentialing disputes in state courts. 

 

Types of Credentialing Cases We Handle

The credentialing attorneys at Jones Law Group have advised healthcare professionals in all specialties, including doctors, nurses, dentists, physicians’ assistants, radiology technicians, pharmacists, and chiropractors. We handle the following types of credentialing cases

Jones Law Group is committed to assisting healthcare professionals who are having difficulty maintaining their hospital privileges in Ohio. We also aid hospitals involved in allegations of negligent medical credentialing. Credentialing cases can become highly adversarial if not dealt with carefully. Our attorneys take a prompt and practical approach to credentialing cases in order to reach non-litigious resolutions when possible. 

If you have received notice that a complaint against you is being investigated or disciplinary action is being considered, be sure to seek legal counsel from our experienced healthcare attorneys before you respond. Our goal is to help protect you and the hospital where you work from claims that you’re not a competent staff member or that the appropriate credentialing procedures weren’t performed. 

 

Get the Personalized Legal Services You Deserve from Jones Law Group

Jones Law Group provides credentialing services to healthcare professionals throughout Ohio. Our attorneys have many years of experience defending credentialed professionals before various administrative and government bodies.

Protect your reputation and livelihood. Contact Jones Law Group today for sound legal advice and unmatched legal representation. Call (614) 545-9998 or contact us online  to schedule a free initial consultation with our team.

 

Steps of the Credentialing Process for Medical Staff

Credentialing is a significant undertaking because of all the information that must be verified before a physician is accepted into a facility. The following are common steps of the credentialing process. 

Collect up-to-date contact information

The healthcare facility must obtain applicants’ up-to-date contact information, so they can check in with them and send them additional forms throughout the credentialing process

Provide detailed instructions

A laundry list of information is required for credentialing, from work history and education to state licensure information. Provide applicants with specific instructions regarding which information they need to send and when.   

Perform a background check & Request peer references

A staff member must go through all of the information provided by the applicant and verify it for accuracy and truthfulness. This may include verifying education and training, verifying current medical licensure, and verifying employment history. 

A physician’s peer references should come from other physicians of the same specialty who are not related by blood or marriage and who are not members of the same practice. 

Investigate malpractice claims

The application should include a section where the physician could address any malpractice claims and explain the situation in their own words. The credentialing coordinator must then compare that information to the physician’s claims history to determine whether they match up. 

Send the application to the governing body for review

Once the credentialing coordinator has verified the information in the physician’s application, the application should be sent to the facility’s governing body for final review. 


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