how to get credentialed with insurance companies

How To Get Credentialed With Insurance Companies

Starting a medical practice requires navigating the credentialing process with insurance companies to ensure timely reimbursement for services rendered. This process, integral for establishing credibility and legitimacy within insurance networks, can initially seem daunting. However, you can streamline credentialing with proper planning and strategic approaches. Begin by securing provider participating contracts from relevant insurance providers in your service area, laying the foundation for a robust revenue cycle. This crucial step facilitates reimbursement for various medical services, from clinical therapies to surgical procedures. While the journey may be challenging, a well-executed credentialing strategy is essential for accessing patients, building your practice, and ensuring financial stability in the healthcare industry.

10 Steps To Get Credentialed With Insurance Company

Understand the Requirements

Different insurance companies have varying credentialing requirements. Research each insurance company’s criteria thoroughly to ensure you meet all the necessary qualifications. Common requirements may include state licensure, malpractice insurance, board certifications, and clean background checks.

Organize Your Documentation

Compile all necessary documents required for the credentialing process. This may include copies of your professional licenses, certifications, malpractice insurance certificates, DEA registration, educational credentials, and any other relevant documents. Keep them organized and readily accessible to streamline the application process.

Complete Application Forms

You can submit your application using the online credentialing portals of most insurance providers. Ensure you correctly and thoroughly fill out all forms, supplying the needed information. Applications that are erroneous or incomplete may be delayed or rejected.

Gather Provider Information

If you’re credentialing on behalf of healthcare providers, gather their personal and professional information, including their educational background, work history, certifications, and other relevant details. Accuracy is crucial to avoid delays in the credentialing process.

Submit Required Fees

Some insurance providers may require payment of credentialing costs. Be ready to send your application and any required fees. Maintain documentation of all payments made for future use. 

Follow Up Regularly

After submitting your application, follow up regularly with the insurance company to ensure the process progresses smoothly. Address any requests for additional information promptly to avoid unnecessary delays.

Prepare for Verification 

Insurance companies will verify the information provided in your application, which may include contacting your references, verifying your credentials, and conducting background checks. Be prepared to provide accurate and timely responses to any verification requests.

Monitor Application Status

Stay informed about the status of your credentialing application by regularly checking the insurance company’s credentialing portal or contacting their credentialing department. Persistence is key to ensuring your application isn’t lost in the shuffle.

Maintain Accurate Records

Keep detailed records of all communications, submissions, and interactions related to the credentialing process. This documentation can be invaluable for tracking the progress of your application and resolving any issues that may arise.

Be Patient

Credentialing can be time-consuming, often taking several weeks to several months to complete. Remain patient and persistent throughout the process, and don’t hesitate to contact the insurance company if you have any concerns or questions.


In conclusion, getting credentialed with insurance companies is crucial for medical billing and coding companies to ensure smooth operations and reimbursement for services rendered. You can navigate the credentialing process by understanding the requirements, organizing your documentation, completing application forms accurately, and following up regularly. Remember to maintain accurate records, be patient, and stay persistent throughout the process. With proper planning and diligence, you can establish strong relationships with insurance companies and ensure the financial viability of your business.