What is medical credentialing?
Credentialing is the process of verifying a provider's qualifications to ensure that they can provide care to patients.
Ensuring providers who are practicing in a given state or city have received all the necessary training and experience to safely and efficiently practice medicine.
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Medical credentialing and privileging usually consists of a few different processes: provider credentialing, provider enrollment, and privileging.
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Provider Credentialing – Before a provider or organization can bill an insurance carrier, the provider must first be credentialed by the carrier. Credentialing is the process by which a health insurance carrier formally assesses a provider's qualifications, and competency based on demonstrated competence. the process of verifying the skills, training, licensing, qualifications, etc. mentioned above
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Provider Enrollment – the process of enrolling a provider with insurance plans.
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Privileging – approving providers to perform specific procedures and granting them a specific set of privileges
To ensure accurate credentialing, here are the necessary medical credentialing criteria that is likely needed:
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Internship/Residency/Fellowship’s Information
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Board Certifications
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Provider’s CV
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Education and training
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Licensing
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Specialty certificates
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Qualifications
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Career history
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Background Checks/ Fingerprinting
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If you sign up for our physician credentialing services, we can assist you with provider enrollment and becoming an in-network provider so that you can receive reimbursements from each carrier. Yes, We have contacts!
THINGS TO KNOW ABOUT CREDENTIALING
it’s important to know that credentialing may take a while. Credentialing can take anywhere from 90 to 150 days, depending on the market. Give yourself plenty of time to complete your credentialing.
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​Staying current with relevant organizations, like the Coalition for Affordable Quality Healthcare (CAQH), can help make your credentialing process a little simpler.
What Information is Required for Credentialing?
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Information is dependent on payers but tends to be relatively consistent across the board and typically includes:
• license to practice and primary source verification
• NPI number
• DEA license
• work history
• degrees and transcripts
• references from previous employers/practitioners
• insurance information
• board certification
• malpractice claims history
• license history (suspensions, revocations)
Why Choose AIMMCCS Credentialing Service?
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Outsourcing your medical provider credentialing to our team of experts, efforts can be consolidated; our team is credentialing dozens of providers at once, every single day. This allows us to consolidate steps and save time and money in the process.
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We work with practices both large and small, including solo practitioners as well as large 30+ provider practices as well as 1 and 2 provider practices for both Medicare, Medicaid, and Commercial Payers for a group and individual enrollment.
Our team has extensive knowledge and expertise for multiple specialties and services, including DME and all provider types.