Credentialing is a process used to evaluate the qualifications and practice history of a provider. This process includes a review of a provider’s completed education, training, residency, licenses, and other attributes. It also includes any certifications issued by a board in the provider’s area of specialty. Insurance companies/payers conduct this process before the provider is permitted to bill for their work. These insurance companies/payers review providers’ credentials on a regular basis, following standards established by states, regulatory bodies, and accrediting organizations.
This process is absolutely essential to a practice being successful. Not only is this process done at the initial setup, but this also has to be kept current. Data that is collected and used to update each insurance company/payer must be accurate and complete. Experience with the credentialing process is a must. This can be time-consuming as well. Our firm can provide this service on a timely basis and keep all data complete and compliant. The cost to outsource this process is cost-effective.