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Understanding Credentialing

Credentialing in the healthcare industry might be presented to you my different names but its the same required process when dealing with the insurance companies.

  • Insurance Credentialing: Also known informally as “getting on insurance panels,” this term refers to a health insurance company verifying a physician’s credentials. Every health insurance company checks the credentials of a physician before it includes the doctor as an in-network provider.

  • Paperless Credentialing: This term refers to software that expedites the credentialing process, decreasing or eliminating the need for paper forms.

  • Medical sales rep credentialing: Also known as vendor credentialing, this refers to healthcare organizations checking on and monitoring the background and training of sales reps and other vendors who may want or need access to the facilities.

Credentialing is also used in non-medical contexts, including the following:

  • Personnel Credentialing: This is when an organization assigns credentials to its employees or vendors.

  • Political Credentialing: This term refers to political parties assigning credentials to delegates for party conventions.

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