Medical Credentialing

You could be at risk of losing potential patients to a competing practice

It was only a couple decades ago that healthcare professionals considered medical credentialing—that is, the process of getting enrolled in an insurance company’s preferred provider network—to be an optional step in building their medical practices or an unnecessary step to growing their client/patient caseloads.

Back then patients did not expect every healthcare provider to accept their insurance (some corners of the healthcare industry, like mental health services, weren’t even covered by most insurance plans). Also, many patients had “out of network benefits,” which meant that the patient could meet with a doctor of his/her choice and then file for reimbursement from his/her insurance company later. Oh, How Things Have Changed.

Today, it is more necessary than ever for physicians and healthcare providers to be in-network (AKA: “credentialed”) with insurance companies. This is a necessity, in part, because more people in the United States have health insurance than ever before. And it is a necessity because people today demand that their healthcare providers accept their insurance. Put bluntly, if you are not in-network with a potential patient’s health insurance plan, you’re at risk of losing that potential patient to a competing practice.