Question: What is credentialing?

A. It is a process by which insurance carriers and hospitals to verify the credentials of medical providers. These include the verification of licenses, the examination of irregularities insurance, review the college degree and background checks on all crimes or criminal activities.

Question: Why is credentialing important? Who is it important?

A. It is important that the provider to maintain his credibility with the insurance carrier, and hopefully get a contract to participate in a variety of insurance company programs. This is vital for medical providers due to the fact that most of us want to see a doctor in our network, as it creates a savings for us with our medical costs. Most of the network services require us, the patients with a deductible before any payments to providers of services.

Q. How does the medical aid provider credentialing?

A. After a medical provider credentialed and accepted to be an insurance policy, then their information in the provider directory. If a patient is looking for a medical provider in their network, they usually search by zip code. If a medical provider is not included in this directory, medical has missed the opportunity to create a new patient. Credentialing therefore in a sense is a marketing tool as well.

Q. How does a medical provider go about the process of credentialing?

A. Credentialing is a very lengthy process and requires an individual undivided attention. Latest Documents must be connected to a standard application designed to give for readability. Documents include licenses, certificates, CVs, and the statement of the actual wrongdoing. A cover letter should accompany the application and documents, the introduction of the provider to the carrier or the hospital. Most providers use an external service for this process.

Question: How long does it take to be credentialed?

A. Most airlines take from 90-180 days to their credentialing process. Once credentialed provider, the application goes before a committee for final inclusion in an insurance plan.

Question: How will providers know whether they are accepted into a plan?

A. Most airlines the supplier by post together with a welcome package of some type. Another method is to make your application, someone at the institution every few weeks to check the status of the application.

All in all, credentialing is a very important part of the medical provider business.

Michele Graham
CEO and owner of Professional Healthcare Management
Billing and Credentialing Services
41 years in the Healthcare Industry

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