{"id":8659,"date":"2019-04-22T10:00:43","date_gmt":"2019-04-22T04:30:43","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=8659"},"modified":"2021-01-15T13:00:20","modified_gmt":"2021-01-15T07:30:20","slug":"what-is-the-insurance-credentialing-process","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/what-is-the-insurance-credentialing-process\/","title":{"rendered":"What is the Insurance Credentialing Process?"},"content":{"rendered":"

Credentialing is a process that the insurance companies use to verify your education, training, and professional experience and to ensure that you meet their internal requirements for serving as an in-network provider on their panel. The goal of the insurance credentialing process<\/strong><\/a> is to become in-network and prevent your patients from having claims go towards their out-of-network deductible.<\/p>\n

The process of credentialing with an insurance network actually consists of two phases- Credentialing and Contracting.\u00a0 The contracting phase is where the company issues you a participating provider agreement that defines the terms of participation for receiving in-network reimbursement for your claims. Without a participating provider agreement, you will not receive in-network reimbursement.\u00a0 Until your credentialing and contracting are complete you may have the option to bill the network as an out-of-network provider, but there is no guarantee of your claim being processed.\u00a0 Government health plans such as Medicare<\/a> and Medicaid will not pay for any out-of-network services.<\/p>\n

Checklist items for credentialing and contracting preparation:<\/h2>\n