In Medical Credentialing

One of the most important administrative tasks that healthcare professionals and organizations must stay on top of is ensuring that their healthcare credentialing certifications are always accurate and up to date.

However, with increasing amounts of admin time and paperwork involved in the medical credentialing processes, it can become a huge burden on healthcare facilities.

Any kind of small mistake or oversight can lead to a lapsed certification of a healthcare professional, which will lead to issues with insurance payments for services already provided. Let me explain how this process works and why it’s critical for all medical services.

What is Physician Credentialing?

Physician credentialing is a certification process that verifies all professional records relating to a healthcare professional’s training, education, licensing, and experience. It’s a vital requirement for doctors, surgeons, nurse practitioners, and many other professionals who directly and indirectly deal with medical patients.

While the medical provider credentialing process varies between different medical professions, the concept is the same. The goal is to receive a professional certificate that confirms that the person has all the necessary education and training to practice medicine.

It’s also a way for healthcare organizations to validate the skills and experience of new and existing employees.

There are multiple benefits of healthcare credentialing that we will outline shortly. But the most important reason for staying up-to-date with medical credentialing is that insurance companies can withhold payments if any certificates are not current.

It’s also important to understand that medical credentialing is not a one-time process. Most medical professionals will have to go through a credentialing process every three years.

Benefits For A Healthcare Provider

There are several key benefits for healthcare professionals when they are able to stay on top of their credentialing. And it’s not all just about having a certificate for the office wall.

Patient Confidence and Trust

Trust plays a critical role in every doctor-patient relationship, and unfortunately, that trust is often taken for granted. Even more important, it can be very difficult to build up that trust with people who might be going through a very traumatic time in their life,

For all healthcare providers, it’s critical to do everything possible to demonstrate that all employees providing medical services are fully credentialed.

It immediately shows new and existing patients that staff have the education, training, skills, and experience necessary to help them get better. And the more trust you can build up right from the start, the more confidence they will have to go ahead with recommended treatments.

Higher Professionalism

While there is a lot of paperwork involved in medical provider credentialing, this is a time and effort investment that can instantly pay off by providing healthcare facilities with a professional appearance.

It also shows patients and vendors that you care enough about the education and experience of medical staff to make the effort needed to achieve and show off all the credentials.

Seeing a certified document as proof that all credentials have been professionally verified is simply something you can’t do without. And you don’t want to end up in a situation where patients or an insurance company ask for credentials and not be in a position to provide them.

Reduced Medical Errors

According to research statistics, medical errors are involved in almost 100,000 deaths in America each year. That’s a staggering number that is down to many different reasons.

However, healthcare providers can protect themselves from becoming a significant part of such statistics by ensuring that all staff are always fully up-to-date with their credentialing. Only with the right supporting documents that confirm a provider has the necessary training and education will such credentials be issued. And because all documents have to be up-to-date to renew credentials, it can help healthcare providers avoid hiring medical staff who may not satisfy all the requirements. More on these shortly.

Ensure Timely Payment

One of the most immediate impacts of medical credentialing directly involves revenue and cash flow for a medical services provider. And it all comes down to the contracts between medical providers and insurance companies.

These contracts include clauses to specify that reimbursements are dependent on all medical practitioners involved in a treatment having fully up-to-date credentials. This means that if there is an issue with renewing credentials on time or if a filing mistake leads to delays in receiving credentials, then insurance companies will withhold payments until the matter is resolved.

How Does The Medical Credentialing Process Work?

The physician credentialing process is a time-consuming admin task that requires training and experience to ensure that all the requirements are in proper order and available for review. And for many organizations in the medical industry, that means allocating admin staff to stay on top of this vital business practice.

Credentialing Prerequisites

While there are differences in the medical credentialing process from state to state, as well as for different professions, there are some typical items that you have to check off before you make an application.

Here are the most important ones:

Certificates of education and training
Medical board certifications
Work history and experience
Full history of clinical privileges
Contact information for employment references
Clinical performance reviews
Medical malpractice insurance claims history
Professional licensing certificates

Some of this information, like education certificates, won’t change much over the years. But, keeping track of clinical privileges and your work history is more difficult to manage.

That’s why it’s important to keep notes about any changes in these areas so that you have all the necessary details when it comes to renewing credentials.

Application And Processing

Once you have collected all the necessary details, it’s time for a healthcare provider to validate that all the information is accurate. This may involve primary source verification for new employees to ensure that previous experience and training records can be backed up.

An application, along with all the supporting documentation, is then submitted for the appropriate verification, where it’s reviewed and verified. Depending on the work history and amount of training throughout a career, this process can be quite time-consuming.

This application process also involves reviewing any registered complaints against medical practitioners that may have previously been registered.


Medical provider credentialing is not a once-off process. In most cases, medical staff have to go through a re-enrollment process every three years in order to keep their credentials up-to-date. All existing holders of credentials will receive notification when they are due for renewal. But as with many such notifications, people often leave it too late, or they miss them altogether.

That can lead to lapsed credentials and a stressful time to rush through the process. That’s why it’s important to either have dedicated admin staff to stay on top of such tasks or to outsource credentialing to DataMatrix.

Outsource The Credentialing Process With DataMatrix

Credentialing is a vital administrative business process but one that involves a lot of time and paperwork. And because small mistakes in the handling can lead to long delays, it’s important to have someone experienced in the process available.

Most healthcare providers try to handle this in-house, but it can lead to a large administrative overhead.

That’s where outsourcing physician credentialing to DataMatrix becomes a huge time and cost-saving. Not only will this ensure that you always stay on top of your credentialing requirements, but it will also free up your admin staff to deal with other important tasks to help with patient care.

Call us today to find out how we can streamline your entire credentialing process or to learn about how you can pair our services. From medical transcription to prior authorizations, we offer services to keep your practice running efficiently!

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