Medical Credentialing Services
Credentialing Overview
Insurance credentialing is the process by which healthcare providers (such as doctors, therapists, clinics or hospitals) become approved by insurance companies, including Federal and State programs, to accept their insurance plans. This involves submitting an application, documentation of qualifications, licenses, and certifications, as well as undergoing a thorough review of the provider’s background, education, and professional history.
The real purpose of credentialing is to ensure that the healthcare provider meets the standards set by the insurance company, which includes verifying their education, training, licensing, and ensuring they have no history of malpractice or fraud. Once approved, the provider can then bill and receive payments from patient services who are covered by that particular insurance plan. In most cases, providers cannot treat patients, nor attain payments until the credentialing process is complete.
The process is complex and time-consuming and it varies among insurance companies, regions and states. It involves multiple steps, filling out applications and online forms, providing supporting documentation, undergoing background checks, and waiting for approval. This can take several months and the process will be greatly prolonged if not executed correctly.
In addition, providers need to recredential periodically to maintain their status and to continue accepting insurance payments. This process ensures ongoing compliance with the insurance company’s standards and requires provider’s information is up to date.
Credentialing specialists are comprised of trained and experienced professionals that understand the urgency, deadlines, logistics, provider specialties and licensing as well as the disparity between payer protocols so that we can expedite applications for the best outcomes for the provider and practice.
Selecting a vendor for your insurance credentialing involves many considerations. You want a partner that understands enrollments, the impacts to revenue and has business experience and longevity in the field. Contact us today to learn how our team can exceed the level of support you expect, permitting you to focus on what is most important and that is taking care of your patients.
