Credentialing Verification


Credentialing Verification Services Overview

Professional Healthcare Management, established in 2004, addresses the credentialing requirements of various managed care organizations, hospitals, and other health care entities.

The verification process begins with a practitioner receiving and completing a Practitioner Application, which is available in both hard copy and electronic template. The form collects critical information regarding education, training, board certification, licensure, hospital privileges, and malpractice insurance. The form also asks necessary questions related to licensure sanctions, medicare/medicaid sanctions, felony convictions, and malpractice claim history. The information collected is then entered into the PHM Network Credentialing database and primary source verified including a query to the National Practitioner Data Bank. All information is held highly confidential, according to Professional Healthcare Management’s strict security policies.

The information housed in the Credentialing Database allows Professional Healthcare Management to provide preprinted forms, applications, and reports. This capacity frees the practitioner from spending valuable time completing multiple forms/applications and decreases duplicative efforts. At recredentialing, the use of a preprinted application or profile means that the practitioner need only review, update, and attest to the information originally provided on the application.

Professional Healthcare Management verifies practitioner’s credentials using criteria that is compliant with the National Committee on Quality Assurance (NCQA) and the Joint Commission on Accreditation of Hospitals (JCAHO).

Professional Healthcare Management routinely supports the credentialing and privileging processes that take place in all entities and aims to reduce duplicating efforts and improve the verification process. Contracts with other clients may be established on a case-by-case basis.

For more information on how Professional Healthcare Management can reduce your time by working with your organization to complete this tedious task, please call 866-480-1612 and one of our agents will be happy to assist you or email us at

Credentialing Verification Services

  • Initial Credentialing
  • Re-Appointment & Re-Credentialing
  • Pre-Populated Application Services
  • Continuous Credentialing Services
  • Rush Services
  • Status Reports and Monthly Updates

Our Customers Include:

  • Credentialing Departments
  • HMO’s, PPO’s, PHO’s, MSO’s, and IPA’s
  • Home Health Agencies
  • Hospitals and Hospital Systems
  • Managed Care Organizations
  • Medical Staff Offices
  • Outpatient Surgery Centers
  • Payer-Sponsored Networks
  • Medical Centers and Clinics
  • Provider-Sponsored Networks

Pre-Populated Application

  • Using Professional Healthcare Management’s standard application form, applications can be pre-populated from Professional Healthcare Management’s database to reduce provider errors and time required to fill-out forms

Continuous Credentialing

  • Tickler System Provider for monthly updates of time-sensitive documents
  • Tickler System Updates Medical License, DEA and CDS Certificates, and Malpractice Coverage


  • Applications are completed in 30 days or less, contingent on receipt of requested provider documentation.