Frequently Asked Questions


Medical Credentialing


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Frequently Asked Questions

About Credentialing

Credentialing can be overwhelming and confusing for many medical practices.

MD Services Medical Credentialing is a solution – let us handle the processes, follow up calls and deal with the insurance companies for you.

Because we know our business, we can get it done efficiently through our accurate work and knowledgeable experience.

Here are some answers for you to review about the medical credentialing process.

What is medical credentialing?

Medical credentialing is the process of obtaining, verifying, and evaluating the qualifications of a medical professional to provide care or services within or for a healthcare organization.  Credentials are documented evidence of education, training, experience, licensure and other qualifications. Before an insurance company will reimburse for healthcare services provided to their members, they want to verify that you are qualified and legitimately providing those services.

Who needs medical credentialing?

Any medical practitioner or organization who wishes to bill insurance companies as an in-network provider needs medical credentials.  These include physicians, hospitals, dentists, therapists, counseling offices, chiropractors, optometrists, urgent care facilities, social workers, treatment centers, nurse practitioners, etc.

Why is medical credentialing needed?

When medical professionals get credentialed with insurance companies, it means that they are able to service patients with those specific insurance companies.  These patients’ claims can then be billed directly.  The result is an increase in patients who can access your medical services.

What is the first step in getting credentialed?

The first step is to call us!  We will gather your information as well as discuss what insurance companies you wish to work with based on your practice location and type of license. Then, on your behalf we will do the retrieving, completing, submitting and follow-up of your applications.  We work closely with you, keeping you informed and timely responding to your questions.

How long does the credentialing take?

Credentialing often takes other medical credentialing services 120 days or longer to complete, but our efficient methods enable us to guarantee turnaround within 60 to 90 days.  Some exceptions apply, please ask for details.

What is recredentialing?

Once you are credentialed with an insurance company, they will require recredentialing to make sure that your information on their system is current and accurate. Commercial payers require recredentialing every three years. Medicare and Medi-Cal require recredentialing every five years. MD Services Medical Credentialing also provides recredentialing services to ensure that your credentials do not lapse.