What is Medical Credentialing?

Credentialing, in general, is used in various contexts in different fields. In this instance, the term credentialing refers to Medical Credentialing or insurance credentialing. Both Medical Credentialing and Insurance Credentialing are used interchangeably. Physicians and other healthcare practitioners, such as a hospital, a counseling office, a chiropractor, a Dentist, a Physical Therapist, an Occupational Therapist, an optometrist’s office, Urgent care, a Treatment center, a Social worker, etc, who wish to bill an insurance company as an in-network provider must undergo a process of credentialing.

Once a provider is credentialed with an insurance company, they can bill that company directly. In addition, most insurance panels will also provide “in-network” providers with referrals and preferential reimbursement rates. Many panels split the credentialing process into two parts. There is a credentialing phase and a contracting phase.

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