What is Credentialing?

Credentialing is ultimately the process of collecting and verifying medical professionals’ qualifications. It is a compilation of evidence of a physician’s license, education, experience, etc. This process is a way for others to assess that the medical provider is indeed competent. One party that needs to verify a healthcare provider’s credentials is, for example, insurance companies.

The entire process to getting the credentials is time consuming, involves the preparation of many documents and long waiting times. However, this service can be outsourced or you can use electronic services such as the one powered by the Council of Affordable Quality Healthcare (CAQH), to help make the process easier.

Although a seemingly complicated process, whichever way you choose to complete it, having the credentials will be beneficial to you and your practice.

Credentialing and Patient Trust

Credentialing can improve patients’ trust in the physician. It is a long process and once items such as a physician’s identification and background are verified and approved, it is a signal of the physician’s qualification. This acts as a sign of trust to the patients, giving them a full understanding of the physician’s skills, knowing that they have been verified through an official system. If a patient does not know much about the physician’s background, there may be less trust. With patients’ trust in your practices and providers improved, your practice’s reputation will also improve.


Just as credentialing increases patient trust, credentialing also increases your facility’s trust in the healthcare providers it hires. If individual providers have credentials or get verified, it acts as a signal that their competencies will meet the facility’s requirements. Additionally, it will allow new hires to practice within the insurance network.

Credentialing and Insurance

Insurance companies need to verify providers’ credentials before going intro contract with them.  Once the provider is verified, they are eligible for a contract with the insurance company. Contracted practices or providers are what are known as “in-network”, and in-network providers are subject to negotiated rates on reimbursements. This can protect you, as a facility or physician, by easing the reimbursement process. If out-of-network, the reimbursement rates may vary and insurance may not pay as much as in-network, contracted rates. Overall, credentialing can help with the reimbursement process and help your practice with the necessary funding it needs to help more patients.


Our post on medical billing terms talks about “in-network providers” along with some other common terms you may hear about.

Decrease Risk of Legal Issues

As a facility or physician, you may have many documents that you need to keep track of. Through credentialing, it brings to your attention information from the past that you might have forgotten, decreasing the chance you miss any important legal documents.

One thing to note is that by electronically, streamlining the credentialing process, you can also decrease the risk of missing any crucial documents and pieces of information that is needed to verify you or your practice, saving time from having to re-submit documents for review.

Improving Your Practice

Credentialing creates a system of unified trust between patients, providers, and insurance companies. As a healthcare provider, you want patients to have trust in you, and if you run a facility, you want to have trust in the providers you hire. Getting verified by insurance companies can help with the reimbursement process. Credentialing also decreases legal risks. This way, you and your facility can focus on caring for your patients with less worry. Whether it is through helping more patients or collecting reimbursements with more ease, credentialing can help your practice grow.

Americare Network

If you are looking to go through the credentialing process but do not know where to begin, we deliver electronic credentialing services powered by the Council of Affordable Quality Healthcare (CAQH). We’ll make this process easier for you and your practice. Contact us today to learn more about credentialing and our other services.