General Category > General Questions
Credential question
lgentle:
I am real new at this and I would like someone please tell me what Credential is? Is it some type of insurance the need and where do you find the application?
Thank you, lgentle
PMRNC:
It's the process a provider/group goes through to join a health plan for participation status.
lgentle:
Is this something I need to be filing or does the provider? If I need to fill this out where do I get the forms? lgentle
PMRNC:
It's NOT a one form type of thing. Each carrier has their own method of credentialing. If you are doing billing for a client who has existing contracts you should familiarize yourself with them, however I would not undertake the services of credentialing if you do not have experience. There is a process to credentialing and it should not be done unless you know what you are doing. It is the full process (with each carrier) of "credentialing" onto their panel. Contracts, fee schedules, etc are factored into the process.
KimGailey:
I found a great website to do credentialing at www.caqh.org
My question is, does a Dr have to complete credentialing with the insurance company to file a claim with them? If they don't do the credentialing, wouldn't it just be out of network?
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