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Importance of provider credentialing

Importance of provider credentialing

What is the credentialing process for healthcare providers?

Provider credentialing is the process of establishing that medical providers have proper qualifications to perform their jobs. This requires contacting a range of organizations, including medical schools, licensing boards, and other entities, to verify that the providers have the correct licenses and certificates.

What are credentialing services?

Credentialing is the process of verifying a provider’s qualifications to ensure that they can provide care to patients. Most health insurance companies require this process including CMS/Medicare, Medicaid, and Commercial plans, as well as hospitals and surgery centers.

The providers credentialing process is completed by verifying all of a provider’s documents to ensure that they are valid and current. These include their medical license, malpractice insurance, and DEA.

Why is credentialing so important?

Medical credentialing is increasingly important because it is the one procedure that allows patients to confidently place their trust in their chosen healthcare providers. Through a standardized process involving data collection, primary source verification and committee review by health plans, hospitals and other healthcare agencies, patients are assured of their healthcare professional’s merit and experience. With the start of web services and other technology innovations, credentialing is therefore a prime area for increased efficiency and process improvement.

Generally, physicians need to engage in a tedious, paper-based credentialing process before a health plan can contract with the provider or a hospital can grant affiliation. However, this burden can be greatly reduced. Electronic credentialing processes offer organizations efficiency, thereby reducing the burden on all stakeholders and positively impacting quality.

How long does it take to get credentialed?

Many providers always have one doubt that how long does it take to get provider credentialing? It can take anywhere from 60-120 days, but that is only if you provide all of the information correctly the first time. If there is a petition process, lobbying, or appealing, it can take between 190-220 business days.

Can providers see patients before payor credentialing is done?

Some plans will officially let you bill under a supervising physician once the credentialing of the new physician is underway. Ask every plan if they will accept a Statement of Supervision from a physician enrolled in the plan, so the new physician can start seeing patients.

Are you looking for provider credentialing services?

If you’re looking for help with medical billing or credentialing, let our credentialing experts help you to get credentialed with top insurance companies. Contact us at

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