What is Credentialing and Re-Credentialing
Medical credentialing is the process by which healthcare providers are evaluated for their qualifications and eligibility to offer medical services within healthcare systems. Re-credentialing, on the other hand, involves periodic reassessment to ensure that providers continue to meet the required standards. This process is essential to maintaining quality, safety, and compliance within the healthcare industry.
-
PECOS & CAQH Management
Managing your profiles in the Provider Enrollment, Chain, and Ownership System (PECOS) and the Council for Affordable Quality Healthcare (CAQH) is vital for insurance participation. We ensure your Medicare enrollment is current and your CAQH profile is re-attested on time, preventing gaps in your ability to bill commercial and government payers.
-
Provider Documents Management
Maintaining a centralized and organized repository of provider documents—such as medical licenses, DEA certifications, and board certifications—is crucial for administrative efficiency. Our management system tracks expiration dates and handles renewals, ensuring your practice never faces a compliance lapse due to an expired credential.
-
Compliance and Continuity of Care
Credentialing and re-credentialing are vital to comply with healthcare regulations, including federal and state laws, as well as the policies of health insurance companies. This helps prevent legal issues, ensures proper billing and reimbursements, and maintains a high standard of care for every patient.
Flexible Solutions
Custom billing plans tailored to your practice size and specialty. We adapt to your workflow, whether you're a solo provider or a multi-location clinic.
Complete Patient Support
End-to-end patient billing and communication services. From verifying benefits to resolving billing questions — we handle it all with care.
Questions About Credentialing & Re-Credentialing
Medical credentialing is the process of verifying the qualifications, experience, and competency of healthcare providers to ensure they are qualified to provide care within healthcare systems.
Medical credentialing ensures that healthcare providers meet specific standards and regulatory requirements, which helps improve patient safety, trust, and the quality of care delivered.
Re-credentialing typically occurs every 2-3 years, depending on the healthcare organization and regulatory requirements, to verify that the provider still meets the necessary standards and qualifications.
Credentialing is the initial process of verifying a provider’s qualifications, while re-credentialing is a periodic review to ensure the provider continues to meet the necessary standards for patient care and safety.
Proper credentialing ensures healthcare providers are eligible for reimbursement from insurance companies. It helps in avoiding billing errors and ensures timely and accurate reimbursement for services provided.