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Provider Credentialing Blog Posts

Top Strategies for Ensuring Successful Provider Credentialing

Patrick Dougherty

One of the most important steps for onboarding a new provider for your practice is credentialing. Failing to get a new provider credentialed by payers could result in no payment for services unless a patient’s plan allows for out-of-network benefits. Credentialing involves verifying the facts such as the state licensure, medical school certificate, malpractice carriers, and also includes a background investigation of the physician’s financial and criminal history. 

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Topics: Provider Credentialing

Outsourcing Provider Credentialing to a Medical Billing Company

Patrick Dougherty

The Provider Credentialing Process Explained

Credentialing a new provider to validate his or her qualifications, work history, board certifications and references are critical for all healthcare organizations as well as smaller practices.

 Normally, there are two separate processes to credentialing:

  • Privileging approves a provider for performing a specific set of privileges or performing certain specific procedures.
     
  • Provider enrollment is inclusion of a new provider in all of an organization’s insurance plans, ensuring that correct and full payment is received for their services.
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Topics: Provider Credentialing

5 Tips for Simplifying the Provider Credentialing Process

Patrick Dougherty

Provider credentialing an essential part of making sure your practice gets paid. If a doctor in your practice isn’t credentialed by a Medicaid plan, Medicare, or insurance company, you may not get paid unless out-of-network benefits are available to that patient. Unfortunately, sometimes the actual credentialing process can be time-consuming and frustrating for everyone involved. However, there are a few ways that you can simplify the process while avoiding rejections and saving time. 

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Topics: Provider Credentialing

Provider Credentialing Steps for Success

Harold Gibson

Credentialing takes time, but unless your physicians and providers are fully credentialed it can delay your reimbursement – or even cause it to be denied entirely. The credentialing process includes verifying the provider’s expertise and abilities and is essential if you accept insurance; you can’t bill an insurance company without it.

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Topics: Provider Credentialing

Provider Credentialing Is the Biggest Compliance Issue for Practices

Patrick Dougherty

The sooner your credentialing issues are taken care of, the sooner you can focus on the day to day issues of serving patients and receiving timely payments. Ignore the significance of provider credentialing at your own risk - it is certainly one of the most important compliance issues that a medical practice encounters.

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Topics: Provider Credentialing

About this blog

A place for physicians and other healthcare stakeholders to share and discover information about everything related to running efficient medical practices.

Established in 2002 by a group of physicians, we are a national provider of medical billing services to group practices, clinics, and individual physicians. We also specialize in provider credentialing, payer contract reviews, and medical coding for a wide range of clients - from solo practitioners to multi-site, multi-specialty practices.

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