Frequently asked questions
What is medical credentialing?
Medical credentialing is the process of verifying a healthcare provider's qualifications to ensure they meet industry standards and can deliver safe, competent care. This process is required for physicians, nurses, and other healthcare professionals to obtain hospital privileges, work with insurance networks, and comply with regulatory requirements.
Why is credentialing important for healthcare providers?
Credentialing is a crucial process in the healthcare industry that ensures providers meet the necessary qualifications, maintain professional standards, and deliver safe, high-quality care.
What is Primary Source Verification (PSV)?
Primary Source Verification (PSV) is a critical step in the credentialing process for healthcare providers, ensuring that their qualifications, licenses, and credentials are authentic and valid. PSV involves obtaining and verifying information directly from the original or primary source rather than relying on copies or self-reported data.
In credentialing, what does the term "delegated" mean?
An arrangement, usually formalized through a written contract, in which a healthcare entity, such as a health plan or payer, transfers its credentialing responsibilities to another organization, such as a hospital or a Credentialing Verification Organization (CVO).
How long does the credentialing process take?
The credentialing process typically takes 90 to 120 days, depending on the health plan.
What is CAQH, and why is it important for credentialing?
CAQH ProView is a centralized database used by many insurance companies to collect and verify provider credentials. Keeping your CAQH profile updated ensures a smoother credentialing process with participating payors.
Can I start seeing patients before my credentialing is complete?
This depends on the payor. Some insurance companies offer "retroactive billing" once credentialing is approved, while others require full approval before a provider can bill for services. Always verify with the specific health plan.
How can Pinnacle Credentialing Solutions, LLC help with credentialing?
Pinnacle Credentialing Services, LLC offers expert guidance and support throughout the credentialing process, saving providers time and resources.