What is Credentialing?
Credentialing is the verification of a provider’s information to ensure that they meet the criteria outlined in the company’s procedure to become an in network provider. Typically this includes primary source verification of the following; License, DEA, CDS, Medical Education, Training Verification, Malpractice History, etc)
To become an in-network provider with an insurance carrier, providers must first complete the credentialing process. Each carrier may have different criteria and processes.
To have privileges at a facility (hospital, nursing home, dialysis center, etc) providers must complete the credentialing process of each hospital and be approved by their credentialing committee.