Glossary
Provider credentialing is the process of verifying a clinician’s qualifications, such as licence, training, work history and malpractice history, so that insurers can confirm they are eligible to treat and bill their members.
It is closely related to payer enrollment, which is the separate step of getting the provider approved to bill a specific insurance plan. Both must finish before claims can be paid reliably.
Applications can take weeks to months, so practices start well before a new provider’s first patient visit and track every application until an effective date is confirmed.
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