Provider Credentialing
Credentialing is the process by which healthcare providers apply to participate in insurance networks. Without proper credentialing, providers cannot receive in-network payments, which typically results in lower reimbursement and higher patient costs.
The credentialing process involves submitting detailed information about the provider’s:
- education
- training
- licensure
- malpractice history
- practice details
Many payers now use CAQH (Council for Affordable Quality Healthcare) as a central credentialing repository, allowing providers to enter their information once and have it shared with multiple payers.
Credentialing Timelines
Credentialing timelines vary by payer. Medicare credentialing can take up to 90 days, while commercial payers typically complete the process more quickly.
In smaller practices, the billing specialist is often responsible for initiating and tracking credentialing applications.