Payer Credentialing for Providers: The Heart Of A Practice’s Financial Health

Payer Credentialing for Providers: The Heart Of A Practice’s Financial Health


Payer credentialing and enrollment, also known as medical credentialing or insurance credentialing, is the process by which a healthcare provider applies for inclusion in a health insurance network in order to receive payment.

Until the process is successfully completed, a practice can’t receive reimbursements, which is why payer credentialing goes to the heart of a practice’s financial health, just as much as the delivery of quality healthcare.

The problem for office staff is that credentialing is time consuming, complex, requires professional-level expertise, and must be maintained at different renewal cycles for many different health plans, Medicare and Medicaid, continually-merging health systems, and expanding practices. Information compiled from a variety of sources must also be submitted without error because errors take time to correct and cause delays in payment.

Contact Us

Credentialing is Never Over

Maintaining up-to-date credentials for a physician across all contracted payers is an ongoing endeavor that can be as time-consuming as first-time credentialing.

The best-case for the time it takes to complete the process for a single credentialing and enrollment process is usually 30 days, but more likely to take 60 to 90 days. For insurance companies, it can be six months or more. This means that scheduling a realistic timeline for each credentialing task is just as important as the hours that administrative staff has to dedicate to credentialing.

The Credentialing To Do List

Here are just some of the documents that have to be procured and/or verified for the payer credentialing and enrollment process. So it’s no wonder office staff can become stressed:
  • Medical license
  • Medical school information
  • Internship/Residency/Fellowship’s Information
  • Board certifications
  • Provider’s CV
  • License to practice
  • NPI number
  • License history
  • DEA license
  • Work history
  • Degrees and Transcripts
  • References from previous
  • Employers/practitioners
  • Insurance information
  • Malpractice insurance
  • Malpractice claims history (suspensions, revocations)

Keeping a Practice as Healthy as its Patients

Despite the many challenges payer credentialing presents to staff, the process remains essential for the health and growth of a practice.

It’s why many practices consider outsourcing this process. The ideal payer credentialing resource provides both the technology to address every aspect of the task, as well as a team of professionals who are well-versed in the requirements and nuances of accurate, efficient credentialing.

The Medusind Advantage

Working in all specialties, Medusind stays current with the ever-changing requirements of Commercial Insurance Credentialing and Enrollment for major carriers, including United, Anthem, Aetna, Cigna, Humana, and more — as well as Medicare and Medicaid.

In addition to Medusind’s industry-leading technology, a team of credentialing experts, meaning actual humans (not 800 #s, chat bots or voice mail), are always available to answer questions, address issues, and provide support whenever they’re needed.

Medusind Credentialing = A Healthy Bottom Line

Upgrading to professional-grade payer credentialing can help improve efficiency and increase revenue so that staff can concentrate on taking care of people, not paperwork. With Medusind payer credentialing, a practice can thrive as much as its patients.

See how Medusind can work for you

Tell us about your business or organization and we’ll connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. See how a provider, office manager, or biller use Medusind to empower their practice.