Payor contracting is the process of hiring a company to provide health care services on your behalf. It can be used by employers, providers, or others who are not employed by insurance companies. Credentialing refers to a system that enables individuals, groups, and organizations to prove their competence in specific areas of expertise. While credentialing facilitates the process of making an informed decision about who can provide care and what they offer, it is also considered essential to protecting patients from fraud, waste, and abuse.
If you are starting your own health business, then you may not be aware of the benefits of payor contracting and credentialing. This system streamlines the process for payors and health care providers, by streamlining credentialing, which leads to lower costs for both parties. You can also save time by working more efficiently with the right people. This article will cover more about payor contracting and credentialing benefits in the health business.
What is Payor Contracting and Credentialing?
Payor contracting is the process of finding a provider to provide health care services on behalf of people who have insurance.
Credentialing is a system that enables individuals, groups, and organizations to prove their expertise in particular professions. In the U.S., credentialing can be accomplished in many ways—through licensing, certification, or accreditation.
How Payor Contracting and Credentialing helps Health Businesses
- Reduce Costs: One of the benefits of contracting for care services is that it can reduce costs for organizations. In addition to reducing operating costs, contracting also helps businesses by saving on labor and capital expenses.
- Improve Quality: Payor contracting and credentialing are an efficient way to provide quality care because they require providers to adhere to standards set forth by organizations that set quality expectations. This allows organizations to easily identify non-compliant providers and intervene early in the process before serious problems arise.
- Protects against fraud and abuse: For example, if a provider experiences a drop in income or evidence of fraudulent activity in his/her bank account after taking payments from patients, he or she can be caught by an organization’s credentialing system which can allow them to stop their offer of care services before it causes significant harm to patients or their finances.