What is Credentialing?

by Michele Carter-Graham on April 9, 2015

Insurance Credentialing (Provider Credentialing or “Getting on Insurance Panels”) is the process of becoming affiliated with insurance companies so that you (the provider) can accept third party reimbursement.

While just a few years ago health professionals considered insurance credentialing “optional” for building a practice, today it has become more necessary than ever for providers to be networked with insurance companies. In part, this is because more persons/patients in the US have health insurance than ever before, and because patients desire (even demand) to use their health insurance when seeking out health care services (in lieu of out-of-pocket payment).

In addition, insurance credentialing is becoming more important as health insurance plans are becoming broader in regards to the scope of treatments that they cover. These changes include Mental Health / Behavioral Health parity, less restrictions on pre-existing conditions, and the coverage of supplemental services such as physical therapy, massage therapy, acupuncture, and other holistic health services.

The majority of the insurance panels will allow you to apply for insurance credentialing right after you received your license. But there are a few that want a year, two years, or even three years. There are different regulations for each state. Some will require two years, and BCBS in GA, for example, only requires two years.

But there are ways to get credentialed sooner. Usually you can get credentialed if you are past one year of holding your license. Since a lot of the credentialing process is regulated by the state, even with national insurance companies, the state has much to do with the process to apply.



About Michele:
Michele Graham is the CEO of Professional Healthcare Management, a leading provider of medical business management services. Professional Healthcare Management started in 2003 and offers services to all medical professionals for credentialing and insurance contracting. We have performed services for over 3000 providers and multiple hospitals, surgical centers and wound care centers. Our fees are competitive and our staff is comprised of experienced professionals with years of experience in the healthcare industry. Michele has over 40 years experience in healthcare and we welcome anyone having issues getting contracted or getting paid. We try and negotiate better reimbursements for each and every provider....call for more information!

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