Insurance credentialing is the process of verifying the qualifications and credentials of healthcare providers in order to be eligible to participate in an insurance plan. It involves submitting documentation about the provider’s education, training, and professional experience to the insurance company.The credentialing process typically involves completing an application and providing documentation, such as proof of education, training, and licensure. The insurance company will review the application and documentation and make a decision on whether to credential the provider.
Re-credentialing is the process of renewing a provider’s credentials with an insurance company. This may be required on a regular basis, such as every two to three years.
The credentialing and re-credentialing process can be complex and time-consuming, and it is important for healthcare providers to stay up-to-date on the requirements of the insurance plans they participate in. Some of the documentation that may be required for credentialing or re-credentialing include:
- License and certification: Providers may need to submit copies of their medical license and any relevant specialty certifications.
- Education and training: Providers may need to submit transcripts or other documentation of their education and training.
- Professional experience: Providers may need to provide information about their professional experience, including the names and addresses of previous places of employment.
- Malpractice insurance: Providers may need to provide proof of malpractice insurance coverage.
- References: Providers may need to provide the names and contact information of professional references.
By completing the credentialing and re-credentialing process, healthcare providers can ensure that they are eligible to participate in the insurance plans that their patients use. This can help them get paid for the healthcare services they provide and improve their ability to serve their patients.