Credentialing

Medical credentialing is the process by which hospitals, healthcare organizations, and insurance carriers obtain and evaluate the necessary documentation for medical practitioners to join a network or treat patients at a medical institution. This critical process involves contacting various organizations, such as medical schools and licensing boards, to verify a provider’s education, training, licensure, work history, regulatory compliance record, and malpractice history. Credentialing ensures that there are no issues that would deem a provider incapable of adequately treating patients, thus safeguarding patient safety and ensuring the quality of care.

Additionally, timely and accurate medical credentialing is essential for maintaining a smooth revenue cycle and avoiding delays in payer enrollment and re-credentialing, which could negatively impact a provider’s ability to serve patients and receive proper reimbursement.