What is Medical Credentialing?

Medical credentialing is a process used to evaluate the qualifications and practice history of a doctor to establish competency. This process includes a review of a doctor’s completed education, training, residency, and licenses. It also includes any certifications issued by a board in the doctor’s area of specialty. Hospitals, insurance providers, Medicare and Medicaid conduct medical credentialing to determine which physicians meet their requirements prior to permitting them to practice in their network. These entities continue to do so, on a regular basis as dictated by states, regulatory bodies and accrediting organizations. While this may seem like a simple, straight-forward process, each hospital and third-party agency requires their own specific type of medical credentialing processes, forms, rules and requirements. Therefore, it is imperative to know the specifics of each hospital or agency in order to save time, money, and headaches.

Getting Credentialed

As you can see, credentialing is an arduous process, especially since each entity has its own requirements. Click each category below to find out more information.

  • Information for new Physicians
  • Health Plans
  • Medicare & Medicaid
  • Hospitals