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Everything You Need to Know About Insurance Credentialing

Everything You Need to Know About Insurance Credentialing

Posted on August 5, 2021

Insurance credentialing is the process with which certain insurance companies tend to verify the training and education along with the professional experience of the medical professionals to ensure that they can meet the requirements for serving as the in-network provider for any particular panel. Most healthcare professionals these days tend to opt for insurance credentialing to prevent the patients from getting claims that reach outside their network deductible.

What Are The Importance Phases of Insurance Credentialing?

There are 2 important phases to the entire process of credentialing with any particular insurance network. These phases are known as credentialing and contracting. In the contracting phase, the company will issue a participating provider agreement to the profession with certain defined participation terms provided to receive the in-network charges for several claims. Without having the agreement of the participating provider, there is no chance of receiving the in-network reimbursement from the insurance network. Until both the phases are complete, the professionals can bill the network using their out-of-network technique. However, there is no guarantee for the processing of the claims in the first place without the completion of contracting and credentialing.

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