In a recent article (Internet claims conundrum in Benefits Canada March 02, 2012), Bob Carter emphasized that the provider credential process, is an essential part of the eClaims (or Internet Based Claims – IBC) process.
An extensive protocol must be established to ascertain whether or not a provider is a member in good standing of any standards councils or self-regulating organizations. Unknown providers must be held in a pseudo online escrow while their legitimacy is established. Nonchalance can be a breeding ground for potentially abusive claims.
The Provider Directory can be leveraged by carriers to screen providers’ credentials during the claims submission process, and thus:
- build up a consistent local provider database and
- flag suspicious providers and claims before adjudication.