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Medical Billing and Credentialing Services: Everything You Need to Know

Medical Billing and Credentialing Services: Everything You Need to Know

If you run a private practice or own a healthcare facility, it’s essential to stay up to date with credentialing requirements for your organization. With different choices available for patients, the best decision for your practice is to meet the contracting need of payers. 

As a healthcare provider, you aim to grow your business. The more patients come to you for care, the more revenue you will end up generating. To become attractive to your potential consumers, it’s significant that your facility attains the trust of insurance companies. This can be achieved by meeting the credentialing requirements of those particular companies. 

Understanding Credentialing in Medical Billing

Providers must be credentialed to be able to successfully gain the trust of insurance companies. This is essential for contracting. Many patients refuse to visit doctors which are out of the boundaries of the insurer’s network. 

Healthcare providers need to enhance and grow their patient base to remain relevant and generate revenue. This can be done by meeting all the requirements set by insurance companies. Once you get done with credentialing, you can move forth and contact them to get insurance reimbursements for medical services your patients have utilized. The insurance companies call this process contracting and credentialing. 

As a part of credentialing, the insurance providers will verify the primary source, this includes academic history, licensing, and other competencies of your healthcare facility. This process mostly takes 60 to 180 days. As a medical provider, you would also need to ensure that you omit any errors which could potentially contribute to a delay. 

Once the credentials are verified, the insurance companies will extend a contract and add your facility to their network. 

The Credentialing Process

Your application is the beginning of this process. Ensure that the form you’re using is up to date. Often insurance companies would update their forms and, significantly, you’re filling out the latest one. 

Once you get done with all the sections, ensure all the information you entered is correct. If your paperwork consists of errors, this could delay the process of credentialing. There is no telling how long will the delay last, hence it’s better to avoid errors, to begin with. 

You must also get a copy made of your completed finalized form. This is to maintain a record in case paperwork gets lost during transit. Your copy would serve as proof that you have completed everything that was required from your end. 

Another factor to be mindful of is that you must not omit any information. Any malpractice or other claims should be clearly stated. During the credentialing process insurance companies do their homework extensively. During which any claim that comes into notice would seem alarming if you go out of your way to hide it. It’s better to remain transparent, otherwise, they would not send you a contract. 

What happens after the application process?

Once you are done with various forms, rechecking the documents, and you making the submission, you should follow up. You must get in touch with the insurance company and inquire about the status of your submitted application. This also allows you to double-check that all the necessary documents have been successfully submitted. 

In a nutshell, this stage would require you to make several phone calls and write emails. It might also require you to make a personal visit till your application gets approved. 


Credentialing in medical billing plays a significant role in getting the attention of a subsequent patient base. Once you are listed in a network of insurance companies, patients would choose your facility to opt for medical care. This would allow your healthcare facility to grow and gain trust among patients. 

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