CAQH: Definition, Explanation, Importance

Council For Affordable Quality Healthcare Defined And Explained CAQH: The Council Defined CAQH, or the Council for Affordable Quality Healthcare, is a non-profit organization of national healthcare networks and plan providers whose objective is to improve the quality of healthcare and its accessibility. It’s primarily designed for providers and their staff in order to eliminate […]

Hospital Credentialing: What to Expect as a Physician

It doesn’t matter whether you work in private practice or work for a hospital group. Almost every physician has to go through credentialing and privileging at some point in their career. These two terms are used interchangeably in the medical community, but do you know what they mean? Do you know what they’re for or what […]

Credentialing, Provider Enrollment, Privileging – isn’t it all the same?

Not really. While these 3 terms are often used interchangeably, they actually have different meanings: Credentialing, as defined by Joint Commission, is the process of obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health care organization. During this process, which hospitals and health plans use, […]

Outsourcing Credentialing and Provider Enrollment

When we meet with potential clients, some hesitate to externalize their credentialing and enrollment processes. Outsourcing, however, provides various perks and benefits that help your organization function at optimal levels, gain market share and increase profit. Operating costs are the expenses that are associated with a business’ day-to-day maintenance and administration costs. The total operating […]

Provider Contracting and Everything You Need to Know

The provider contract is a vital element for any health care provider who wishes to operate a smoothly run facility with high patient satisfaction and on-time payments. However, there are many different types of healthcare provider contracts. Each is filled with lots of unfamiliar legal jargon and confusing clauses, amendments, and stipulations.  To get a […]

Private Practice & Insurance Billing

Healthcare providers venturing out into private practice often are unsure about establishing their procedures for third-party billing networks for services. The process of billing and reimbursement refers also called the “Revenue Cycle.” The first step in the revenue cycle is to obtain credentialing and a participating provider contract with insurance companies important to your service […]

Private Practice and Insurance Credentialing

Private Practice and Insurance Credentialing Healthcare providers trying out into private practice often are unsure about establishing their procedures for third-party billing networks for services. The process of billing and reimbursement sometimes refers to as the “Revenue Cycle.” The first step in the revenue cycle is to obtain credentialing and a participating provider contract with […]