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How Medical Credentialing Can Benefit Your Practice

Medical credentialing gives peace of mind to your patients and can help you gain an insurance partner.There are several avenues for medical credentialing, any one of which can benefit your medical practice. A large part of medical credentialing has to do specifically with credentialing doctors, or evaluating the doctor’s 1) practice history and 2) qualifications. From education to residency and every step in-between, a doctor’s credentials are important to verify. This also includes licenses or certifications either elected or mandated, which fall under the doctor’s area of specialty (if applicable).

The benefit of doctor credentialing is easy to see, especially if you have ever been a patient. Patients want to know that their doctor has knowledge, experience, and a clean, positive record. It gives them peace of mind and therefore raises their opinions of your medical facility. In regards to your clinic, it also raises the general quality of care and helps to maintain HIPAA standards regarding doctors who may have previously violated regulation. It’s the method by which a doctor who moves across state lines after committing fraud, etc. may be found out and denied work.

A clinic can gather background information by:

  • Formal application to either the National Practitioner Data Bank or the American Board of Medical Specialties.
  • Contacting claimed learning institutions and previous places of employment.
  • Calling the Drug Enforcement Agency (to check that he/she is authorized to write prescriptions).
  • Checking with Medicare/Medicaid that the doctor is not banned from caring for those patients.

In this way, medical credentialing protects your medical practice, staff, and patients. You may also conduct a review of the following:

  • Confirmation of active medical malpractice insurance coverage.
  • Malpractice claims history.
  • Previously lost or limited hospital privileges.

Medical credentialing can additionally enable you to find the best insurance networks to partner with on providing in-network care. This process can be difficult because researching the most widely-utilized insurance providers is time-consuming. It also requires intricate details and a lot of paperwork to apply for in-network status.


Would you like to move forward with medical credentialing for your practice? Partnering with insurance providers is a big step toward a long-lasting and successful practice. Billing Advantage can help you take the busy work out of the process. We offer a credentialing service that will manage the mountain of monotonous paperwork necessary to apply, and help you fill in any missing information quickly. Find out more about our medical credentialing services today!

Donna Whipple Donna Whipple

Donna Whipple, Psy.D. is a clinical psychologist with over 30 years of management experience. She has particular interest and expertise in HIPAA and ethical treatment and business practices in a changing high tech industry. She has a particular talent in boiling down complex regulations so providers can understand and comply with them. As co-owner of Billing Advantage Inc., Donna is involved in all aspects of the company but her particular contributions to the business is in mentoring upper level managers and helping them be more effective in their leadership.

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