What is Medical Credentialing?

Medical credentialing is the process of verifying information about medical staff and physicians to ensure legitimacy and experience. States and insurance providers conduct medical credentialing to determine which hospitals and private practices meet their requirements. Hospitals and practices will also use their own employees or hire outside firms to conduct the verification process with medical staff candidates.
 
Medical credentialing is a very thorough, time-consuming procedure. The length of the process depends on the applicant and the laws of the state where the hospital or practice resides. Physicians take a much longer time to investigate because licensures, completion of residency programs, authentication of services, and other qualifications must be confirmed.

Physician credentialing may also involve investigating any liability claims, references, association memberships, and status with the Department of Health and Human Services.

Medical Credentialing is the process of becoming affiliated with insurance companies so that you (the medical provider) can accept third party reimbursement. While important for the success of a clinical practice, medical credentialing is an unwelcome distraction from providing quality care to patients–but it doesn’t need to be!

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