About Credentialing /Enrollment

Provider Credentialing

Credentialing refers to the process of verifying the proven skills, training and education of healthcare providers. Verification of the providers credentials are done by contacting the “Primary Source”, which has provided the license, training and education. The credentialing process is used by healthcare facilities as part of their hiring process and by insurance companies to allow the provider to participate in their network. Credentialing is also the validation of a provider in a private health plan and the approval to join the network.

Provider Enrollment

Enrollment refers to the process of requesting participation in a health insurance network as a provider. The process involves requesting participation, completing the credentialing process, submitting supporting documents and signing the contract. Enrollment is also the validation of a provider in a public health plan and the approval to bill the agency for services rendered.