Insurance Credentialing 101

Insurance Credentialing is the process by which healthcare providers (such as doctors, therapists, and clinics) are verified and approved to participate in an insurance company’s network. This involves the insurance company reviewing the provider’s qualifications, licenses, education, training, work history, malpractice history, and other professional credentials to ensure they meet the insurer’s standards. Once approved, the provider becomes “in-network,” meaning they can bill the insurance company directly for covered services.

What’s Checked: Education, licenses, certifications, work history, malpractice records, training, level of value and community need.

Why Its Important

• Patients pay less when seeing in-network providers.

• Providers can expand their patient base.

• Builds trust and credibility.

• Meets legal and regulatory requirements.

Why Hire a Professional to Process Credentialing?

• Overall, it saves you time, effort, and money.

• We’re familiar with the process and we already have contacts to solve issues that commonly arise during processing.

• The process will be done efficiently, and correctly the first time - allowing you to spend quality time with your patients.