Credentialing, also known as primary source verification, is a comprehensive process that insurance companies use to verify the qualifications of a healthcare provider to determine whether you are eligible to become a part of their insurance network. They review all of your background and documentation to make this determination. The information necessary to complete each credentialing process includes:
- Medical license
- Malpractice insurance
- Medical school information
- Internship/Residency/Fellowship information
- Board Certifications
- Provider’s CV
You must complete this process for most health insurance companies, including Medicare, Medicaid, commercial plans, and hospitals and surgery centers.
Once the process is complete and you are approved, the insurance company will extend a partnership contract to you to become a part of their provider network.
At Excellent Medical Billing Services, our credentialing experts will manage this entire process for you, for as many providers as you like. We are well-versed with the CAQH (Council for Affordable Quality Healthcare) profile that is required by over 900 health plans, hospitals, and healthcare organizations.
Obtaining your initial credentialing is very important, but that is not the end. These records must be updated regularly. From new insurance enrollments to annual or biannual review requests, we will keep your details up to date with Medicare, Medicaid, insurance companies as well as local facilities and hospitals.
Advantages of Medical Credentialing with EMBS
For healthcare providers, the advantages of being credentialed include the ability to work within more insurance networks and therefore offer your services to more patients. It is more important now than ever to use credentialing to build your practice. Many people will only see a healthcare provider who carries their insurance, so to make sure you are available to as many patients as possible, you need to consider working in as many insurance provider networks as possible.
Patients also benefit from the credentialing process, as they can be assured that their healthcare practitioner is highly qualified and is maintaining rigorous standards to maintain credentials and contracts with insurance providers and other facilities.
Disciplines That Require Medical Credentials
Medical credentials are required for a variety of medical practitioners including the following:
- Physician Assistants
- Advanced Practice Nurses
- Marriage and Family Therapists
- Social Workers
Facilities That Require Medical Credentials
Many facilities and services are also required to obtain and maintain medical credentialing, to show that they also meet the high standards to operate and provide medical services. These facilities and services include the following:
- Alcohol and Drug Recovery Centers
- Diabetes Education Providers
- Durable Medical Equipment
- Home Health Services
- Hospice Care
- In-Home Care Services
- Independent Diagnostic Testing
- IV Home Infusion Therapy
- Laboratories and Laboratory Collection Sites
- Radiology/Diagnostic Imaging
- Sleep Disorder and Sleep Study Clinics
Is Self-Credentialing Worth It?
As you see from the description above, credentialing for medical billing is a tedious, detailed, and time-consuming task. There are many steps along the way and frequently we communicate back and forth with the providers during the qualification review. It likely will take more time and energy for you to try to work through the process yourself, which will take away from your core business of treating patients.
With Excellent Medical Billing Services, there is no need to worry about registration forms and deadlines and extra requests. We have it handled, so you and your team can spend more time with your patients.