Credentialing quintessentially determines the industrial/practice credentials of an individual. It seeks to assess his professional competence through the recognition and attestation of his current medical, professional or technical know-how and performance. This process assesses and monitors a practitioner’s decision-making with regards to clinical or medical reviews and adheres religiously to the applicable professional standards for direct medical care and/or peer review. Patient mix or referrals to outpatient clinics or specialists must never determine a Credentialing process.
The entire Credentialing process verifies physicians/clinicians in terms of their:
License
Experience
Certification
Education
Training
Malpractice and Adverse Clinical Occurrence
Clinical Judgment
Technical Capability
Character in Professional Practice
Key components that go into Credentialing include: peer review and analysis of utilization criteria (determined through standard legal and administrative practices), evaluation of care quality, provided to patients as a whole and examination of practitioner competency records. While performing Credentialing, it is mandatory to strive and maintain consistency and protocol; otherwise the entire process is prone to be elusive. Our team of experts guarantees an effectual and comprehensive background and professional assessment of the physician, maximizing beneficiary safety to the client company. At all times, such records of assessment and decisions are safeguarded and kept private.
Sun Knowledge performs Credentialing activities, complying with the guidelines set by Medicare Managed Care Manual and National Committee for Quality Assurance (NCQA).
