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Medical insurance credentialing is the way insurance companies verify that medical providers are legitimate and qualified to receive reimbursement for services provided. When a provider is credentialed with a given payer, they can bill the payer directly and receive reimbursement.

The credentialing process usually takes between 90-120 days, start to finish. Because of this, if you are getting ready to start a private practice, don’t wait until the week before you open your doors to start the process!

There are numerous important objectives behind the process of medical credentialing — many of them rooted in compliance. Here’s a look at some of the reasons it’s so important, and why healthcare organizations need to prioritize ongoing credentialing:

• Verify the education and training of healthcare professionals. This includes confirming their medical degrees, specialty training, and completion of residency and fellowship programs.
• Validate licensure and certifications. Credentialing organizations verify that healthcare providers hold valid and unrestricted licenses to practice medicine and any additional certifications relevant to their specialties.
• Review professional practice history. This involves checking for any disciplinary actions, malpractice claims, or adverse events related to the provider’s practice.
• Assess professional competence. Credentialing experts evaluate the provider’s clinical skills, experience, and adherence to professional standards.

Medical credentialing is the process of verifying a physician’s qualifications, education, certification, and license to practice medicine. It is a way to confirm that the physician has the necessary skills and expertise in their specialty and meets the standards of their state. Medical credentialing is also known as physician credentialing or doctor credentialing. It applies to other healthcare providers as well, such as nurses, but may have different requirements.

Medical billing and coding is the process of converting diagnoses, medical tests, treatments, and procedures into standardized codes. These codes are then used to bill patients, insurance companies, and government entities for medical services provided. Medical coding is the translation of medical procedures into a universal language, while medical billing is the submission of claims and receipt of payment.

We know that we work for you. Each practice is unique, and our services are customized to meet the needs of each individual practice. Your dedicated Account Coordinator will work with you to achieve optimum efficiency of claim submission. We work in conjunction with the practice staff, the insurance companies as well as the patients to ensure that we have all the required information to minimize errors and delays in payments.