Services

Medical Credentialing Services

An important process for protecting patient safety and quality of care. It grants the privilege to a medical staff member to practice in a certain institution.

medical credentialing services

What Is Medical Credentialing and Why Is it Important?

Medical credentialing is the process of verifying the qualifications and credentials of healthcare providers, such as doctors and nurses, to ensure they meet the standards required to practice medicine. A medical credentialing service helps healthcare organizations and providers with this process by verifying education, training, licensure, and any other relevant information. This service is important because it helps ensure that patients receive quality care from qualified providers. Medical credentialing can be a complex and time-consuming process, but outsourcing it to a credentialing service can save time and resources for healthcare organizations and providers. Medical credentialing services may also offer ongoing maintenance and updates to keep providers’ credentials current.

How It Works

How does provider credentialing work?

01.

Initial consultation

During the initial consultation, the medical credentialing service will gather information about the healthcare provider and the credentialing requirements for the provider's desired practice location.

02.

Application preparation

The medical credentialing service will assist the provider in completing the necessary application forms (credentialing packet) and gathering the required documents.

03.

Verification process

The medical credentialing service will verify the provider's education, training, licensure, and any other relevant information. This may involve contacting schools, professional organizations, and state licensing boards.

04.

Background check

The medical credentialing service will conduct a background check on the provider to ensure there are no disqualifying factors, such as disciplinary actions or criminal records.

05.

Reference check

The medical credentialing service will contact the provider's professional references and gather information about their work history and qualifications.

06.

Decision

Based on the information gathered during the verification and background check process, the medical credentialing service will make a recommendation on whether the provider should be granted credentials.

07.

Ongoing maintenance

The medical credentialing service will keep the healthcare practitioner's medical license, insurance (mal-practice), and CEUs up to date by conducting regular reviews and recommendations as needed. This may include verifying that the provider has maintained their licensure and continuing education requirements.

How Long Does the Medical Credentialing Process Take?

How Long Does the Medical Credentialing Process take?

The medical credentialing process typically takes between one and two months, depending on the complexity of the provider’s application and the requirements of insurance companies. The medical credentialing service can help streamline this process by gathering all the necessary documents promptly and verifying relevant information quickly.

What is Primary Source Verification and CVO?

Primary source verification is the process of verifying the authenticity and accuracy of a primary source, such as a document or record. CVO, or credential verification organization, is a third party service that performs primary source verification for various types of credentials, such as educational degrees or professional licenses. CVOs ensure that the credentials presented by individuals are valid and legitimate. This process verifies the training and experience of the medical provider and ensures the healthcare provider’s qualifications are what they present them to be. 

Frequently Asked Questions

Don’t know what to do? Contract Providers has the answers you need.

Yes, you will need to be credentialed with each insurance company before providing services. Depending on the type of credentialing needed, the credentialing process may vary.

Yes, most medical credentialing services charge a fee for their services. The fees may vary depending on the scope of work and the complexity of the provider's application.

The reimbursement start date is when providers will start receiving reimbursement from insurance companies for services rendered to patients. This is typically determined by the insurance company and the medical credentialing service will work to ensure the reimbursement start date is as soon as possible.

The documents required for medical credentialing vary depending on the insurance company and type of healthcare provider. Generally, documents such as proof of licensing, state medical board verification, liability insurance information, Medicare and Medicaid enrollment forms, and three heretics will be needed. In addition, some insurance companies may require other documentation such as hospital privileges, malpractice history, or other educational qualifications. 

The best practices for medical credentialing include having complete and accurate information ready when beginning the application process, ensuring all documents are up to date and valid, and working with a medical credentialing service that is familiar with the requirements of each insurance company. Medical credentialing services can also help streamline the process by verifying any new practice locations or changes in malpractice coverage quickly and easily. Additionally, they can help ensure that all requirements are met and the provider's information is up to date. Finally, staying informed of any changes in the medical industry is important for providers to ensure they remain compliant with insurance companies' standards. By being proactive and working closely with a medical credentialing service, providers can ensure they remain compliant and maximize their revenue. 

Schedule your free Provider Credentialing consultation now

Don’t wait any longer to get started with medical credentialing. Our team of experts is here to provide you with the best services, including primary source verification, CVO, and reimbursement start date assistance. We understand the importance of staying compliant and maximize your revenue, so we work hard to make sure all requirements are met and your information is up to date. Schedule your free consultation now and enjoy the benefits of expert advice.