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MedsDental Provider Credentialing Service

Credentialing is the process of verifying a provider’s qualifications to ensure that they can provide care to patients. Most health insurance companies require this process including CMS/Medicare, Medicaid, and Commercial plans, as well as hospitals and surgery centers.

The providers credentialing process is completed by verifying all of a provider’s documents to ensure that they are valid and current. These include their medical license, malpractice insurance, and DEA.

Additional Information Necessary To Complete Credentialing:

  • Medical School information
  • Internship/Residency/Fellowship’s Information
  • Board Certifications
  • Provider’s CV

CREDENTIALING PROCESS

What Information is Required for Credentialing?

Information is dependent on payers but tends to be relatively consistent across the board and typically include.

  • Malpractice claims history (Suspensions, Revocations)
  • License to practice and primary source verification
  • NPI number
  • License history
  • DEA license
  • Work history
  • Degrees and transcripts
  • References from previous employers/practitioners
  • Insurance information
  • Board certification

Outsourcing Credentialing and Re-Credentialing

When you elect to handle credentialing physicians in-house, you must assign resources to compile and send out application materials to new providers; track the completion and collect the documents; complete the facility portion of the application and credentialing process (like primary source verification, malpractice claims review, etc.); send the applications to payers; and then respond to any requests for corrections or additional information from payers. Additionally, that person (or team) must track re-credentialing deadlines and initiate, track, and complete the process every time a provider is due for re-credentialing.

Connect With MedsDental

We’ve helped thousands of practices find the right credentialing and enrollment experts for them. Take the stress out of searching for a credentialing specialist and let us find a vetted, experienced billing partner that knows whole process.

Step 1. Connect

Provide us with initials details so the MedsDental RCM team can start the recommendation process.

Step 2. Review Application

MedsDental will reach out to learn more about your business to ensure that your unique needs are understood.

Step 3. Get Your Expert Team

MedsDental will match you with two highly-vetted credentialing expert teams that have extensive experience in your type of practice.

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