July 4, 2022

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Credentialing Verification Services – Why is this Necessary?

1 min read

What is credentialing – This is where hospitals and insurance companies verify the credentials of the doctor. This includes checking for licenses, verifying malpractice insurance, and verifying college degrees. Background checks are also done to check for criminal activity or felonies.

Why are credential authentication services important – Medical providers must do this because most people want to save money on their medical bills. The majority of out-of-network benefits require that we, the patient, pay a deductible before any payments are made to the provider.

Credentialing Verification

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After a provider has been credentialed and is accepted into an insurance program, their information will be posted to the provider directory. 

Patients search for medical providers in their area by using zip codes. A medical provider that isn't listed in the directory will be unable to find a patient. Credentialing is also a marketing tool.

How does a medical provider proceed with credentialing – Credentialing can be a time-consuming and tedious process that requires your full attention. A standard application must include current documents. The application should be typewritten for legibility. 

Documents include diplomas, certificates, resumes, and pages detailing current malpractice. The application should be accompanied by documents and a cover letter that introduces the provider to the hospital or carrier. This is a common process for providers who use an outside service.