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What Is Medical Credentialing & Why Is It Important?

by | Dec 6, 2022

Medical Credentialing

To understand “what is medical credentialing”, you need to focus on the process of getting affiliated with insurance payers. In addition, credentialing can be referred to as verification of healthcare providers whether they are qualified to provide care or not. Discussing the process, it includes the verification of education and training of healthcare providers. After going through the credentialing process successfully, providers can offer services to patients. Also, their network grows and the practice improves in terms of revenue.

What is Medical Credentialing?

Medical credentialing refers to the verification of provider’s credentials and association with the insurance network. Likewise, providers can offer services to maximum patients once they are enrolled with insurance companies. The healthcare providers who are going to begin their practice should go through the credentialing process. Also, it eases the process of getting employed at a healthcare facility and ensures that providers meet the necessary criteria. Physicians who want to expand their practice need to go through the medical credentialing process. Further, credentialing increases the horizon of medical practices as it grows their network and allows them to treat more patients.

Why Is Medical Credentialing Important?

Providing quality care to the patients is the ultimate goal of any healthcare provider. Medical credentialing allows providers to do that seamlessly. Similarly, patients feel comfortable to get treatments and services from providers affiliated with insurance payers. So, it becomes an essential part for the revenue growth of medical practices. Besides this, credentialing is a complex process and takes time and effort. However, it is streamlined if experts handle the complexities of the process.

How Is the Credentialing Process Conducted?

Efficient credentialing services help providers to run their practice successfully and attain more revenues. In addition, insurance companies scrutinize all the documents providers submit for the credentialing process. Likewise, medical practices are verified whether the physicians are trained to provide the services they offer. Once the providers submit the documents, the hospital performs the primary source verification to gather necessary information. If the application is clear from all the sources, the final approval is given to the provider. Now, the provider can work in the hospital after successful completion of the process.

Who Conducts the Credentialing Process?

The facility of a third-party company conducts the credentialing process. If a third-party company runs the process, the healthcare facility will likely be required to use a specific company or provide a specific list of approved companies. Laboratory Billings offers medical credentialing and top-rated laboratory billing services. Also, third-party companies ask for some information about education and experience from providers. Afterwards, they submit a report to the healthcare organization to make sure physicians can start working at the hospital.

3 Things You Need for A Successful Medical Credentialing Process

– Education: The verification of your education is essential. Make sure all the degrees and certifications are recognized by the relevant authorities.

– Licensure: Verifying your license is also important for healthcare providers. In addition, it is essential to practice medicine in a state and gives providers an authority to work. Similarly, not having a license can create problems in practicing medicine.

– References: Getting legitimate references help providers professionally when it comes to credentialing. Similarly, it increases the credibility of the providers when someone gets in touch with the references.


Healthcare facilities use credentialing processes for hiring medical providers. So, focusing on improving this process should be the aim of providers. In addition, knowing “what is medical credentialing” looks like an important concern for providers. Also, making this process seamless leads to starting working at a healthcare facility. Further, medical credentialing helps hospitals find out whether providers are able to offer relevant services to patients or not. The most important thing to consider is that healthcare providers should keep their documents updated and verified. Likewise, they should gather as many potential references as they can and ensure a seamless credentialing process. Outsourcing credentialing to specialists makes sure providers go through this process without hassle.

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