Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy.

Physicians and other healthcare practitioners who wish to bill an insurance company and receive reimbursement for services as an in-network provider must undergo a process of credentialing. This process, otherwise known as primary source verification, is the process in which an insurance company verifies the provider’s education, training, experience, and competency. In order to start this process, the provider must submit a credentialing application that details their training and qualifications to treat patients in their area. Once the verification is completed, the insurance company then decides if the provider meets its internal qualifications to serve as a provider of services to their insured members. After approval of a provider’s credentialing file, the insurance company then issues a participating provider contract that allows the provider of services to bill the insurance company and receive reimbursement as an in-network provider of services.

Medical Credentialing is used interchangeably to refer to insurance credentialing or provider enrollment. Medical billing credentialing services includes the primary source verification process at the payer or facility and the insurance contracting. Medical Credentialing is utilized by healthcare practitioners when they desire to participate with an insurance company such as United Healthcare or Medicare. Credentialing is a necessary process that needs to be understood and embraced by all practice that wishes for their providers to see patients and get paid.

Medical billing services, The processing of medical claims may span over just a few days to several months. On occasions, there are numerous forward and backward movements in the process, and this can occur due to errors in the initial registration and confirmation. Therefore, patient verification and authorization is a crucial step that may be performed on every visit. The primary objective of patient verification is to confirm financial responsibility for the medical services performed. Insurance coverage and plans differ significantly from carrier to carrier depending on the state and the premiums paid. Many healthcare providers hire medical billing and coding services providers to utilize their state-of-the-art technology and to avoid costly errors.