Tag Archives: medical credentialing

Common Questions About Medical Credentialing

Medical credentialing and contracting is required for a provider to receive payment for their services. Medical credentialing is a complicated process that takes time and precision. There are many steps and doing just one thing incorrectly can upend the process. Here are some of the most commonly asked questions about medical credentialing:

How long does credentialing typically take?Common Questions About Medical Credentialing

It takes about three to five months to receive a completed contract.

How does credentialing through a third-party company work?

Outsourcing the credentialing process will save time. Credentialing performed by an individual who does not understand the process will extend the contract completion for many additional months.

What documents are required for credentialing?

Insurance companies require a completed CAQH application which includes current license, diplomas or transcripts as well as a copy of current liability insurance

What’s the difference between credentialing and privileges?

Credentialing is the beginning of enrollment with a health insurance carrier. Once credentialing has been completed, a contract will be required. Privileging grants a doctor the ability to practice in a hospital or other healthcare facility. It authorizes a specific scope of work for a physician and is given after evaluating their clinical qualifications.

Have more questions about medical credentialing? Then feel free to give Medical Revenue Associates a call at 215-497-1001 today.


Credentialing Services: Adding or Removing a Physician from Your Carrier Profiles

Being a practice within a managed care carrier network or multiple carrier networks means inevitably having to add or remove a physician from your carrier profile. This process involves an application process (completing the 30-page Council for Affordable Quality Healthcare (CAQH) questionnaire) for a specific network and must be completed whenever there is a provider…

SGR (Sustainable Growth Rate) delays – again!

Why isn’t Congress supporting our healthcare providers? Every year we go through this agonizing time frame of facing a 20% cut in Medicare payments, while Congress constantly bypasses their responsibility. Congress can’t be penalized for their lack of appropriate actions, so they do what is in their best interests. Typical political selfishness. Our government expects our healthcare providers…