Strong Provider Credential processing, an Essential Step in the eClaims Process.

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:

  1. build up a consistent local provider database  and
  2. flag suspicious providers and claims before adjudication.
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