Credentialing is the process of getting the medical practice recognized by public and provider agencies, particularly insurance companies. Any medical practice that is in the network of a popular insurance company can be sure of continued patients. It is not easy to get a new practice credentialed. One significant aspect of the difficulty is the requirement by CMS (The Center for Medicare Services) to have timely information and updates about attention to patients. If these standards and rules are not achieved, the medical practice can lose its credentials and their in-network status with the insurance companies.

Provider credentialing and enrollment is the process of enrollment and attestation that a physician is part of a Payer’s network and authorized to provide services to patients, who are members in the Payer’s plans.

Credentialing verifies that a physician meets standards as determined by the Payer by reviewing such items as the individual’s license, experience, certification, education, training, affiliations, malpractice & adverse clinical occurrences and clinical judgment.

Our team works with the practitioner and CAQH (The Coalition For Affordable Quality HealthCare). If a provider does not have a profile with CAQH, insurance companies will not keep their Credentialing active.