Medical Billing: What Is Credentialing and Why Is It Considered Important?

In the present era of high-quality medical practice, healthcare organizations are required to ensure patient safety and deliver an acceptable standard of care to the patients. For this purpose, it is necessary to employ well-trained and educated staff.

To maintain high standards in the medical profession, it is very important to know medical credentialing in grave detail. It becomes extremely difficult to work in the healthcare department if you are not experienced with medical credentialing. You cannot prosper ahead if you ignore this important aspect of the medical healthcare industry. So, what is credentialing and why is it so important in the medical industry?

Let’s find out.

Medical credentialing is the establishment of the qualifications of different licensed professionals. This is done to recognize their legitimacy by assessing and running a check on their background.

What is credentialing?

What is credentialing

Credentialing in simpler words is a process of determining the designations of different health professionals by assessing their knowledge, performance, or skill level. They are granted a license or a certificate through a formal process after going through the prescribed guidelines to ensure that the best resources are given to the patients.

It will become extremely difficult for the healthcare operatives to work without medical credentialing. To thrive in this industry, one must be competent enough to perform medical credentialing.

 Healthcare innovation stated,

It is very important for medical and healthcare organizations to have a complete understanding of medical credentialing to prosper and be good at what they are believed to do, that is to heal the world.

Medical credentialing goes back in history as far as 1000 BC. According to the historians, it was the cult of Zoroaster who asked different physicians to treat his three most important heretics. He set a condition that if all of them lived, the doctor who treated them would be qualified to give treatment to other patients till he lived. This is the first known case of medical credentialing. And till this date, this case is considered the foundation when it comes to credentialing physicians.

Now the method of credentialing is different and way more advanced than the cult of Zoroaster times but the basics are the same as they were in ancient Persia.

We have listed below some of the most important reasons why it is mandatory to practice medical credentialing and how it helps a medical organization grow and prosper:

Establishes professionalism

Medical credentialing and that too an efficient one demonstrates the professionalism that you put into your healthcare practice. It sets the pace of the healthcare setting along with the entitlement of irrefutable documentation.

If a healthcare organization takes out time and puts extra effort to fill in paperwork to showcase the credentials of their staff then this assures the patients that they have indeed come to a professional firm that is accredited with bona fides.

Many medical professionals in the past have tried to ace the process of credentialing in the past because the paperwork is too lengthy to wade out. But now, thanks to modern technologies there are newer and easier methods that help you grasp the latest information and induct it into your healthcare system. These new methods can be adopted online as well.

All You need to do is ask your team to stay updated with the electronic credentialing for any given entities which will be changing in the future so that you stay informed beforehand. This will help your organization to stay updated and derive means to work according to the newer updates, increasing the credentials of your firm and professionalism.

You can add all the necessary information in the paperwork about your physicians, nurses, employees, and other staff such as the medical school they went to, the location of the residency or the internship, or the certifications that they have done according to the curriculum vitae submitted to the organization.

You also need to make sure that the medical licenses are all valid and there is no type of malpractice conducted by the said staff member in order to ensure the professionalism of your organization. This will increase the worth of your medical organization amongst the competitors and will keep you on top of the game.

Ensuring confidence in patients

The healing process is time taking. Often it becomes so prolonged that it affects the state of the mind of the patients. People who come to be healed at the hands of the physicians often put complete trust in their doctors. They want to fulfill the orders of the doctors in order to heal. They are ready to change their lifestyles, eating habits, diets, and even exercise in order to get well again. Doctors are given freehand to prescribe the right medication according to them as well as take as long as required to complete a healing procedure.

It is very important for a patient to trust the doctor and continue the treatment and not look around for more competent doctors in the same field. This shows that the patient instills complete confidence in his doctor.

This confidence also booms if the medical organization has all the nurses, doctors, and paramedical staff completely medically credentialed. The organization also appears to be highly appealing for the new physicians, employees like LVNs, PAs, RNs, and other healthcare practitioners for the supporting staff.

Medically credentialed employees also bring along prestige for the organization as that means that all the staff is highly trained and is up to date with the latest advancements in the medical field. Future excellence is determined by highlighting the amazing abilities of the very efficient team of the healthcare organization. This ensures confidence in the patients and they will come in a flock to get themselves treated by the highly qualified staff of the said medical organization which does not take its credentialing lightly.

How does medical credentialing work

Compensation quotient

It is important for a firm to be medically credentialed as this is also a mandatory requirement of the insurance companies. To complete this documentation, patients need to approach the organizations which have their paperwork details set up beforehand. If it is not done already when the patient wants to access the documentation, this can be a complete put-off and the person might move to any other firm because the time frame matters a lot.

The time frame to apply for medical insurance varies from state to state along with different credentialing laws and regulations which need to be fulfilled by the healthcare organizations.

The private healthcare insurance companies as well as the government-owned healthcare insurance companies such as Medicaid and Medicare see the proof of medical credentialing beforehand before letting the staff engage with the patients which have the medical insurance granted.

Adequate medical staff at different levels

Medical credentialing plays an important role in filling up and maintaining the staff levels to serve people and the community. You can fill out the vacant spot with the most competent person making your team more professional and credible.

Medical credentialing makes it easy when it comes to filling the vacant spots in a company. New medical staff for a company can be filled by compiling the paperwork and documentation. The best way to achieve this is by starting medical credentialing as soon as possible.

 It might take about four months to complete the process but once the procedure is complete it will help the organization in so many ways. It will create space for new resources, it will also allow you to hire new credited staff. Once new resources apply for a said job, the application process will be complete for them to fill out.

The human resource department of the said medical organization needs to be on track to keep a check on the credentials of all the possible candidates that applied for the potential jobs. This will help the organization in identifying any problem or obstacle that might occur in the process causing a hindrance in the appointment of new hires.

Medical credentialing help in getting adequate medical staff appointed at different levels of the medical organization. As once the documentation is completed, it is available to be utilized to hire new resources. Thanks to the deep-rooted credentialing process, the best and most competent candidates are hired for the vacant spots, making the organization more competent and credible.

Removes medical errors

This is perhaps the most important reason why a company should opt for medical credentialing. It is very important for a healthcare organization to have proper medical credentials in order to ensure that they provide their patients with foolproof safety and security.

 Medical professionals need to have credentials as well so that their credibility is up to the mark as well. Medical errors can destroy the career of any healthcare professional. It can cause fatalities and deaths and also brings bad names to the organization as well as the physician.

According to a recent report, every year about 98,000 deaths occur in America due to medical error – now you can understand why we said medical credentialing is important. Yes, the staggering number of deaths due to medical errors keeps on increasing every year.

These deaths do not go unnoticed and can cause the healthcare organization to lose its license or get sued by the family of the deceased patient. It is very important to perform medical credentialing before hiring anyone as a person with higher medical credentials will ensure to bring patients to the organization because of the trust in him. The medical credentials of the staff will omit the chances of medical error as well as make the working environment safe and secure for both the physicians and the patients.

Medical credentialing – Need of the time

Medical credentialing need of time

Medical credentialing is the need of time. It is one of the most heated debate topics in the past but now it has been established as a mandatory requirement across the United States of America.

Medical credentialing does not slow down the practice of the physicians, in fact, it fastens it up and also ensures that negligence is avoided.

Medical credentials will enable a physician to stay updated regarding the latest introduction of medical terminologies or advanced technologies. It also means that the credibility of a healthcare organization becomes stronger if medical credentials have been performed on all the staff and a thorough check has been conducted on the staff.

How does medical credentialing work?

Medical credentialing checks the proof of all the legal documentation regarding the education, personal details, training, etc. There is a lot of documentation involved in medical credentialing.

Some of the most common information required for medical credentialing is:

  • Name, gender, date of birth, ethnicity, and personal details.
  • Mailing address
  • Social security number
  • American citizenship information
  • Recent photograph
  • Current curriculum vitae
  • Controlled substances certificates (some states require them)
  • Proof of immunizations
  • Proof of tuberculosis testing records
  • Proof of residency
  • Medical school record
  • Healthcare training certificate
  • Specialties and licensing
  • Certification of board
  • National provider identifier (NPI) number, username, and the password as well
  • Sanctions or any other disciplinary action
  • Hospital or any other medical group affiliations
  • Professional liability insurance proof
  • Malpractice claims and complete history
  • References from peers and colleagues
  • Medical education documentation

All of this information is gathered from you and then it is further cross-checked with the relevant licensing agencies, organizations, and medical boards for further verification. Once the verification process is completed, the credentials are reviewed once again and sent to the healthcare organization to process further and determine the fate of the application.

The complete full proof credentials mean that the provider has not lied about anything and has all the qualities necessary to work for the medical role he applied for.


After reading this article, your urge to ask what is credentialing should be satiated. It is one of the most vital procedures for the verification of doctors, nurses, and other paramedical staff in order to provide the best possible healthcare services to the patients as well as the community.

This verification process has now become mandatory because without medical credentialing even the insurance companies do not step in.

From a financial perspective as well as medical credibility purposes, medical credentialing is one of the most lethal components of today’s medical and healthcare industry for the betterment and prosperity.