Medical Credentialing Services
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We Offers Complete Medical Credentialing Services
True Billing Tech
State-wide Provider Credentialing & Enrollment Services
Application Submission
Healthcare providers initiate the credentialing process by submitting a comprehensive application to the desired insurance networks or healthcare organizations. This application includes details about the provider's education, training, licensure, certifications, work history, and other relevant information.
Verification of Credentials
The credentialing body thoroughly verifies the information provided in the application. This includes confirming the provider's educational background, licensure status, board certifications, work experience, and any other credentials essential to their practice.
Primary Source Verification
Our credentialing organization often perform primary source verification, directly contacting educational institutions, licensing boards, and other relevant entities to confirm the authenticity of the information provided by the healthcare provider.
Review by Credentialing Committee
A credentialing committee or review board assesses the completed application and verification reports. This committee evaluates whether the healthcare provider meets the standards and requirements set by the credentialing organization or insurance network.
Decision and Notification
Based on the committee's review, a decision is made regarding the approval or denial of the credentialing application. The healthcare provider is then notified of the decision, and if approved, they become credentialed with the respective insurance networks or healthcare organizations.
Contracting and Privileging
After successful credentialing, the healthcare provider may enter into contracts with insurance companies, detailing the terms of reimbursement for services. Additionally, in the case of hospital-based privileges, the provider may go through a separate privileging process to ensure they can perform specific medical procedures within the facility.
Ongoing Monitoring and Re-Credentialing
Credentialing is not a one-time process. Healthcare providers are subject to ongoing monitoring of their credentials, including license renewals, certifications, and any changes to their professional status. Periodic re-credentialing is typically required to ensure that providers continue to meet the established standards.