Executive Leadership | Implementation & Support | Contracting & Billing | Credentialing | Development & Marketing

Provider Credentialing

Our provider credentialing department ensures medical professionals meet the necessary qualifications, licenses, and standards to deliver care. This team verifies the credentials of physicians, nurses, therapists, and other providers, safeguarding patient safety and organizational compliance with regulatory bodies like state medical boards, Medicare, and insurance networks.

The credentialing process begins with collecting and reviewing documentation, such as medical degrees, certifications, malpractice history, and work experience. The department conducts primary source verification, contacting institutions directly to confirm authenticity. Background checks, including criminal history and sanctions, are also standard to mitigate risks. This meticulous process ensures providers are competent and legally authorized to practice.

Beyond initial onboarding, the team manages re-credentialing, to keep records current and address any changes in licensure or privileges. They coordinate with providers, local human resources and medical staff services, and payers to maintain accurate rosters and avoid disruptions in billing or patient care. The provider credentialing department ensures regulatory adherence, and fosters trust among patients and stakeholders.