What is Insurance Credentialing?

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 Credentialing with Insurance is Important:

• As a provider, you will expand your patient base, increasing your potential revenue.

• Patients pay less when seeing in-network providers - they’ll come to you before they pay out of pocket.

• You build trust and credibility with the insurance panels, and the community.

  • Believe it or not, insurance panels accept patients after evaluating the need for them in the community and after calculating their value. Amount of years as a provider, continued education and specialty certifications all work in your favor. Keep track of all your specialties, certifications and extra training, and let the insurance companies know you have them - they could get you out of panel closure.

• Helps you maintain compliance with state and federal standards.

  • Each insurance company follows state and federal standards for providers. Maintaining compliance is required when working with them, meaning you are less likely to allow yourself to lapse.

Why Hire a Professional to Process Credentialing?

Let’s be honest, working with medical insurance comes with its difficulties. It’s time consuming and confusing. One company doesn’t work the way another company works.

Processing time to either be denied or considered in-network is anywhere from 60-120+ days on average. A mistake on your application can cause the processing time to reset.

• Overall, working with a professional 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.