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The Importance of Professional Credentialing

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What is Professional Credentialing?

Partnering with insurance carriers is a necessary process for any medical office. Physicians and other professionals must provide a list of verifications to insurance carriers, including Medicare and Medicaid, in order to be eligible for reimbursable expenses.

What Type of Verification is Required?

Professional Credentialing verifications may vary by according to the specifications required by individual insurance carriers but may include the following:

  • Provider Enrollment Application
  • State License
  • DEA License
  • Board Certification
  • Education & Training
  • Hospital Affiliation
  • Malpractice Insurance Certificate
What are the Consequences of Not Obtaining Timely Credentialing?

Obtaining adequate Professional Credentialing to partnering insurance carriers could take up to 6 months. A medical office should include one very important rule in their financial policy. Do not allow any medical office professional to perform services without proper Credentialing.

The results of not obtaining proper Credentialing can result in lost revenues. Insurance carriers will not reimburse any medical office that bills for professionals or for services provided by professionals that have not been properly credentialed.

If for some reason you have allowed a professional to perform services, some insurance carriers will back date your reimbursement to cover services provided. However, there is a limit to the time frame. Taking that risk could cost your medical office thousands of dollars that can never be collected from the insurance payer or the insured.

The safest and most financially viable solution is to submit your provider enrollment packet including any required documentation and verifications as quickly as possible. The success of your medical office depends on it.

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