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FAQs

Helping Medical Providers

About Our Credentialing Services

At Cred-N-Tial Services, we’ve gathered the most commonly asked questions about our medical provider credentialing services. We understand that navigating the credentialing process can be complex, so we aim to clarify and address any concerns you may have. Our team of experts is committed to keeping you informed and empowered throughout your credentialing journey. Look at our answers to common queries. If you don't see your questions listed, contact us directly. We provide the information you need to make informed decisions about your credentialing needs.


What is provider credentialing?


Provider credentialing establishes that medical providers have the proper qualifications to perform their jobs. This requires contacting various organizations, including medical schools, licensing boards, and other entities, to verify that they have the correct licenses and certificates. In addition, the credentialing organization ensures that no past reported issues suggest the providers cannot competently treat patients.

 

Provider credentialing in healthcare is the process by which medical organizations verify the credentials of healthcare providers to ensure they have the required licenses, certifications, and skills to properly care for patients.

 

The process is also called physician credentialing, medical credentialing, or doctor credentialing. Healthcare credentialing is often associated with authorizing physicians, but similar — although sometimes less extensive — systems are in place for nurses and other healthcare providers.

What is provider contracting?


Contracting is the next step after credentialing, also known as enrollment. It is the act of actually signing on with the insurance carrier as an in-network provider.

 

Credentialing is establishing that you carry the specific license and qualifications that the insurance company requires you to be in their network. Contracting is the act of enrolling in their network once it’s confirmed you meet their qualifications.

 

We help you through both pieces of this process.
What is the difference between medical credentialing and insurance credentialing?


Medical credentialing verifies that medical professionals have completed the proper training and hold all required certifications, verifying they are qualified to serve patients. Insurance credentialing is quite similar - it is the process of becoming affiliated with an insurance carrier to be authorized to see patients.

Why is insurance credentialing important and how does it benefit me?


Simply put, being credentialed with insurance carriers gives you access to more patients, bringing more revenue to your office. Those patients will see you as an in-network provider they can select. It allows you to bill them for services provided.

Some of the biggest advantages to you as a provider are:


Credentialing Elevates Patient Trust

The ability to verify your qualifications as a healthcare provider creates trust in a patient’s decision to choose you. 

 

Credentialing Thwarts Lost Revenue

Credentialing helps healthcare providers avoid losing money due to delayed or denied claims and reimbursements. Without proper credentialing, insurance payers are far more likely to neglect reimbursement for treatment.

 

Credentialing Decreases Medical Error

About 795,000 Americans die or become permanently disabled every single year due to medical errors and misdiagnoses. (External link opens in new tab or windowClick here to read a U.S. News article from July 2023 for more on this staggering statistic.) This disturbing volume of tragedy pushes the medical industry to demand higher standards and disciplinary actions. Credentialing lowers the risk of medical errors by ensuring competency.

 

Credentialing Shields You From Lawsuits

Access to a thorough and complete record of a healthcare provider’s credentials is an essential asset in litigation. If you find yourself on the receiving end of a negligence claim, credentialing can be your saving grace, proving you have verified all requirements.

How long does the credentialing process take?


This can vary greatly depending on many factors, but it takes 90-120 days on average. When you contract with Cred-N-Tial Services, we get to work right away and follow up regularly to do everything we can to keep those timelines as low as possible.

How often do I need to renew my credentialing?


The majority of carriers require re-credentialing at least every three years. Some carriers require renewals more often. We stay on top of this so you can focus on your patients.

What is your service area?


Cred-N-Tial Services serves any provider in the United States. Our services are completed 100% remotely.

What insurance companies do you work with?


We are not bound to any specific insurance providers. We can assist you with becoming enrolled with any insurance carrier you would like to start accepting!

Find Credentialing Information

Browse our detailed database for more information on our medical credentialing services.

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Have any further questions about medical credentialing? Or are you ready to book our services? You may fill out our contact form or book an appointment to get started. We will guide you through each step.

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Cred-N-Tial

Services, LLC

Mailing Address:

665 South Pear Orchard Road Ste 106
Ridgeland, MS 39157-4859

Contact Us:

External link opens in new tab or window901-240-0396
contact@credntialservices.com

Privacy Policy

Cred-N-Tial Services, LLC desires to be a responsible participant in the healthcare industry. We make every effort to protect the privacy and confidentiality of our clients and those individuals whose healthcare information may be identified within data received by us for the purpose of medical and or behavioral health Billing, credentialing and payor enrollment services.

Congress signed into law the Health Insurance Portability and Accountability Act (HIPAA) on August 21, 1996. The purpose of HIPAA is to develop and adopt national standards and requirements that would address the privacy and security of personal health information, and in doing so improve the overall effectiveness of healthcare.

Personal Health Information about an individual contained in the process of credentialing provider with health insurance networks, receiving and billing services from physicians, and reviewing reports and summaries of such services will be protected in accordance with the requirements and definitions of this Health Insurance Portability and Accountability Act.

This Privacy Statement has been developed to describe for you what kinds of information we collect and how that information is used, disclosed, and protected.
  • Any disclosure of Protected Health Information for billing purposes or credentialing and contracting will be made in conjunction with covered entities such as a healthcare clearinghouse and/or third party vendors contracted by the health insurance payor guided by the HIPAA regulations for electronic transmissions.
  • We will use and disclose personally identifiable health information for purposes of treatment, payment, and healthcare operations.
  • As a credentialing and payor enrollment and billing company _______ and its parent company, ______ will use Personal Health Information to obtain physician payment for services rendered in conjunction with medical or behavioral health treatment.
  • Subject to certain requirements, health information may be used for public health purposes, for auditing purposes, for research studies, and for emergencies. When required by law we will provide identifiable health information as requested.
  • We are dedicated to observing all other state and federal laws relating to the transmission, storage and access to medical and or behavioral health care data and records.

As permitted by law, we reserve the right to amend or modify this Privacy Statement when changes occur with federal and state laws or other regulations.
If you have any questions about this Privacy Statement or the practices and policies of our company, please feel free to contact us:

Phone: External link opens in new tab or window901-240-0396
Email: contact@credntialservices.com
Mailing Address:
665 South Pear Orchard Road Ste 106
Ridgeland, MS 39157-4859

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