Frequently Asked Questions

CREDENTIALING

Credentialing is the verification of a provider’s information to ensure that they meet the criteria outlined in the company’s procedure to become an in network provider. Typically this includes primary source verification of the following; License, DEA, CDS, Medical Education, Training Verification, Malpractice History, etc.).

Insurance Credentialing

To become an in-network provider with an insurance carrier, providers must first complete the credentialing process. Each carrier may have different criteria and processes. 

Facility Credentialing 

To have privileges at a facility (hospital, nursing home, dialysis center, etc.) providers must complete the credentialing process of each hospital and be approved by their credentialing committee. 

CONTRACTING

The second step to becoming an in-network provider is to contract with the insurance carrier. 

How can MD-Credentialing Help?

We offer full management of both facility and health plan credentialing and contracting. We complete all applications, submit paperwork and perform necessary follow-up for successful credentialing and contracting. 

We ensure timely submission of all applications. Progress reports are provided electronically on a weekly basis, with phone conferences scheduled at your convenience. 

MD-Credentialing understands that all practices are unique. In order to provide you with the best plan for your practice, please contact us today for a personalized quote. .

• New and Established Medical Practices
• New and Established Physicians (MD and DO)
• Nurse Practitioners (NP)
• Physician Assistants (PA)
• Chiropractors (DC)
• Podiatrist (DPM)
• Behavioral Health Professionals
• Physical Therapist 
• Occupational Therapist 
• Optometrist
• Dentist

MD-Credentialing offers specialist care in a variety of fields, including, cardiology, dermatology, gastroenterology, general practice, hospitals, neurology, and radiology.

Please contact us today to request a personalized quote, and we will be happy to send you all of the paperwork to begin working with your practice. This includes our provider information form as well as attachments needed. (Attachments may include copies of your license, DEA, malpractice insurance, diplomas, etc.) 

 It is important to maintain all of your credential information as it changes. In addition, you should reattest your CAQH application every 60-90 days. Insurance companies will typically recredential providers every 18 months. 

•  We can credential and contract your providers as well as maintain your credentialing information. Special attention is needed throughout the credentialing and contracting process and most small practices don’t have a dedicated credentialing employee to manage these issues.  

 We can eliminate your need for a credentialing specialist in your practice. The cost associated with having an employee on your payroll includes not only their salary but health insurance, retirement, facilities and equipment. If you already have an employee who is responsible for these duties they can be reassigned to another area of the practice 

 We can help you apply for your license, DEA, CDS, etc. in your new state of practice. In addition we can help you enroll in the proper insurance plans for your new practice.  

 We can help you apply for your license, DEA, CDS, etc. in your new state of practice. In addition we can help you enroll in the proper insurance plans for your new practice.  

 Yes. If you do not have a CAQH ID we can help you obtain one in the credentialing process. We will complete this application for you and ensure that it is correct and submitted correctly to your insurance plans.   

 Yes. We can help you apply and obtain a group NPI for your new or established practice    

 Yes. We can complete your application and follow up with your hospital to ensure that your privileges are granted in a timely manner.