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Provider credentialing works to authenticate that doctors and nurses are certified and appropriately trained. The credentialing practice also verifies that the medical staff has the prerequisite professional experience to offer healthcare services. All of this is crucial to maintaining higher safety standards in the medical industry.

On the financial aspect, practices and organizations can’t obtain reimbursements for the services rendered from insurance, including Medicare/Medicaid, if they do not have medical credentialing.

Provider Credentialing Process

The credentialing and provider enrollment process involves many crucial steps. To qualify, a provider must complete this process with each health plan they want to enroll in.

For starters, the practitioner provides the required information, which includes their current CV, education, plus training history, contact information, certifications, and licensing details, affiliations with hospitals and medical groups, board certifications, malpractice or sanctions history, peer references, proof of liability insurance, and so on.

The provider organization or health plan then verifies that all information is correct and up to date. If no problems are found, the provider gets awarded a credential. The entire provider credentialing process might take as low as 30 days to complete or as much as 6 months or more, depending if the credentialing information is being sent via mail or fax.

Importance of Provider Credentialing

Below are some important reasons why provider credentialing is essential in the medical industry, these include:

1. Improving Trust Value with Patients

Patient-practitioner trust plays a vital role as your patients believe you are top-class high professionals qualified to take better care of them. Patients who do not know their doctor’s qualifications might be unable to extend their complete trust in the healthcare services offered.

Thus, evaluating and verifying your experience and qualifications in the specialization boosts and creates confidence among patients and let them rely on and develop trust in the select healthcare providers.

2. Avoiding Revenue Losses

Partnering with insurance providers becomes a mandate for healthcare providers, paving the way for a massive influx of patients seeking treatment. This is inevitable as most patients are covered under some insurance policy. Usually, physicians and other healthcare professionals must facilitate a list of document verifications to insurance organizations to be eligible for reimbursement expenses.

Improper credentialing leads to rejection, denials of claims, and patient bills, which significantly drops revenue. The fact is that many medical practitioners still lose thousands of dollars on claims without opting for a proper credentialing process.

3. Eliminating Medical Errors

A massive number of 98,000 Americans die from medical errors per year, which is immensely worrisome. The situation has prompted industry leaders to formulate campaigns for refining standards while also bringing exposure to disciplinary actions against medical and healthcare professionals.

Thus, proper credentialing becomes a vital prerequisite, especially for individual practices, which need help to cope with appropriate credentialing procedures. Interestingly, the digitized and automated outlook of everything leaves little room for human errors.

4. Facilitating Hiring Procedures

Credentialing involves a complete background verification of practitioners or physicians that necessitates their work, education, residential history, and licensing information to get verified. The entire process takes place at the hiring step for a physician to gauge whether or not they are qualified to perform duties properly.

In addition, to become a member of the network, physicians must have credentialing.

5. Boosting Practitioner’s Business

Medical practitioner credentialing facilitates medical practices, along with individual physicians, to offer treatment to patients with health insurance. In the current scenario, one can deduce the high number of patients with health insurance. What this does is automatically elevates a higher number of clientele for practitioners.

Also, patients find it feasible to go to the same practitioner repeatedly; therefore, credentialing supports practices with recurring patients.


6. Legitimizing Physician’s Reputation

Whether you have taken up, undergone, or completed, credentialing adds value to your practice legitimately. When patients look for healthcare practices or practitioners, they look at select aspects that satisfy them to choose your facility.

Patients might and might not have insurance, but a practitioner with proper credentialing can treat patients with or without insurance. 

7. Cost-Saving

For the current uncertain world economy, practitioners and medical practices seek effective turn-key solutions that are also budget-friendly. This way, operations enhancement becomes possible without spending massive resources. With the advent and successful adaptation of e-credentialing, all medical practices can now swiftly migrate from paperwork to data cloud base solutions. Innovative computing solutions work to reduce overall costs while warranting the safety and proper care of patients. 

Final Thoughts

Provider credentialing offers plenty of benefits to healthcare professionals, boosting third-party reimbursements; beating your current competition. Physicians Revenue Group, Inc. is a 24/7 medical billing services outsourcing company in the USA, offering credentialing services to practitioners and practices.

If your practice still needs medical credentialing, it is time to do it correctly. Get in touch with us at to fix an appointment.