Credentialing of providers in healthcare is the process of verifying and assessing the qualifications, skills, and professional background of healthcare practitioners to ensure they meet the standards and requirements for providers with specific insurance and facility and hospital networks. The goal of credentialing is to confirm that healthcare providers are qualified, competent, and adhere to industry standards, legal regulations, and ethical practices.
Our team of credentialing experts are here to remove the hassle and confusion of payor enrollment, facility and hospital privileges and medical licensure of your providers in a painless and cost efficient way. Credentialing also assures the patient that they are being treated by providers whose qualifications, training, licensure, and ability to practice medicine are acceptable.
Healthcare providers submit a comprehensive application with details about their education, training, licensure, certifications, and professional experience.
The licensing status of the healthcare provider is confirmed, ensuring they hold a valid and current license to practice in their respective field and jurisdiction.
Educational qualifications and training programs are verified to ensure the provider has received appropriate and accredited education and training.
Employment history is checked to confirm relevant work experience and identify any disciplinary actions or malpractice issues.
Colleague and peer references may be contacted to gather information about the provider’s clinical skills, professionalism, and interpersonal relationships.
A query is made to the NPDB, a database that tracks adverse actions against healthcare providers, to identify any history of malpractice claims or disciplinary actions.
A criminal background check is often conducted to identify any criminal history that may impact the provider’s suitability for practice.
For providers who prescribe controlled substances, their DEA registration is verified.
Providers may need to undergo credentialing with insurance companies to be eligible for reimbursement. This involves submitting documentation to insurance networks to establish the provider’s qualifications and eligibility.
