Medical Credentialing

Medical Credentialing Service

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Stop Losing Clients
because you don't take insurance.
Call Us At 1-855-664-5154

Medical Credentialing, Insurance Credentialing and Primary source verification.

It was only a couple decades ago that healthcare professionals considered medical credentialing—that is, the process of getting enrolled in an insurance company’s preferred provider network—to be an optional step in building their medical practices, or an unnecessary step to growing their client or patient caseloads.

Back then, persons didn’t expect every healthcare provider to accept their insurance (some corners of the healthcare industry, like mental health services, weren’t even covered by most insurance plans). Also, any patients had “out of network benefits,” which meant that the patient could meet with a doctor of his/her choice and then file for reimbursement from his/her insurance company later. Oh How Things Have Changed.

Today, it’s become more necessary than ever for physicians and healthcare providers many types (including chiropractors, nurses, psychologists, professional counselors, and many others) to be in network (AKA “medical credentialing”) with insurance companies. This is a necessity, in part, because more people in the United States have health insurance than ever before. And it’s a necessity because people today demand that their healthcare providers accept their insurance. Put bluntly, if you’re not in network with a potential patient’s health insurance plan, you’re at risk of losing that potential patient to a competing practice.

Medical Credentialing

Medical Credentialing: Important for Growing a Practice

Medical Credentialing (sometimes referred to as “insurance credentialing” or “provider enrollment”) is the process of becoming affiliated with an insurance company so that you (the medical provider) can accept third party reimbursement.

While important for the success of a clinical practice, “getting credentialed” on insurance panels is often an unwelcome distraction from providing quality care to patients. Enrollment applications can be 30+ pages long, and to ensure smooth processing there’s a lot of necessary, time consuming, follow-up.

Our medical credentialing service exists to take the hassle out of getting “in network” with insurance panels. We also offer Expert Medical Credentialing for Nurses, Doctors and Physicians. Find out more about Nurse Credentialing and Doctor/Physician Credentialing.

The Largest Insurance Plans in the USA

There are a few ways to calculate which are the the biggest insurance companies in the United States. Value of the company, lives covered, company revenue… regardless of how you calculate who’s the biggest, some of the names appear again and again. These are the 800 pound gorillas. These are the insurance companies you very likely will want to work with.

According to 2018 data from the NAIC, Insurance Business America listed the 10 biggest health insurance groups in the U.S. They are:

1. UnitedHealth Group: $156.9 billion, Market share: 14.2 percent

2. Kaiser Foundation: $93.2 billion, Market share: 8.5 percent

3. Anthem: $67.2 billion, Market share: 6.1 percent

4. Humana: $56 billion, Market share: 5.1 percent

5. CVS Health (Aetna, Coventry): $55.4 billion, Market share: 5.0 percent

6. Health Care Service Corp: $36.9 billion, Market share: 3.4 percent

7. Centene Corp: $36.3 billion, Market share: 3.3 percent

8. Cigna: $29.3 billion, Market share: 2.7 percent

9. WellCare Health Plans (Centene): $20.5 billion, Market Share: 1.9 percent

10. Molina Healthcare: $18.5 billion, Market share: 1.7 percent

 

Insurance Plans Today Cover More (pre-existing conditions, mental health and many others)

While in some ways insurance plans are more limited than in the past years (with HMOs and the lack of out-of-network benefits), in other ways patient’s insurance plans are much more robust.

Medical credentialing has become more important as health insurance plans have become broader in regards to the scope of services they cover. These changes include Mental Health and Behavioral Health parity (see the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)), less restrictions on pre-existing conditions (according to healthcare.gov “All Marketplace plans must cover treatment for pre-existing medical conditions. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health.”), and even the coverage of supplemental services such as physical therapy, massage therapy, acupuncture and some holistic medical services.

Insurance Panels: Filling and Closing

Unfortunately for some, insurance panels (that is, preferred provider networks) are becoming increasingly full, meaning the process of getting on insurance panels is becoming more difficult everyday as insurance companies close provider networks and make the barrier for physicians, counselors or any health professionals higher and more difficult to climb.

**That being said, some panels that claim to be “closed” are really just being highly selective about which providers they are adding. Knowing how to position one’s experience and practice can go a long way when it comes to getting into “closed” panels.**

An Insurance and Medical Credentialing Service Can Help

This website provides helpful articles, videos, and tips about how to get credentialed with insurance companies. Alternately, if you’re looking for a medical credentialing service that can take the burden of credentialing off of your plate, we can do that too.

There are few things in life and business that truly pay for themselves. We’ve set our prices to be affordable, so much so that if you turn just one potential patient away—just one—you would have been better financially having us help you with your medical credentialing. The value of just one client or patient greatly outweighs the cost of medical credentialing.

We’d love to talk with you! Call us at 1-855-664-5154.

How Long Does the Medical Credentialing Process take?

The process of getting on insurance panels (if you’re taking a DIY approach) can be both challenging and lengthy. It generally takes between 3-4 months to submit the necessary paperwork, tender supplementary documentation, and correspond with insurance companies’ credentialing departments, before getting approved to join an insurance panel. However, at times the process can move along much faster. For example, Employee Assistant Programs (EAPs) tend to process in as little as 4 weeks. However, on the other hand, if an insurance company is running behind, or if there’s a problem with a physician’s/healthcare provider’s application, the medical credentialing process could take even longer than 4 months.

Because of the large amount of paperwork and correspondence required, medical providers generally find the process to be very time consuming.

Let us help you with your practice’s medical credentialing, give us a call today: 1-855-664-5154.

Thank you so much for all of your help with this! You all have been really wonderful to work with and I would highly recommend you to anybody who is looking for help with credentialing." Lorena Abarr - Massachusetts
I recently started the insurance credentialing process with Thriveworks, and must say it has been a pleasant experience so far. Great customer service, attentive staff, very prompt and responsive." Christa Surerus - Minnesota
Just writing a note to tell you that Laura Peak has been doing an outstanding job for my credentialing. She is kind, professional, prompt, and available. She has made building my new practice much easier- and is much appreciated!" Dr. Nick Garg - Pennsylvania
Medical Credentialing Reseach
We Surveyed Practicing Medical Billers, and asked them about Top Insurance Companies

Read what we found out...

  • Insurers Most Likely to Reject Preauthorization
  • Lowest Paying Insurance Companies
  • Insurance Companies Most Likely to Audit You
  • Insurance Companies Most Likely to Take Money Back
  • The Fastest Paying Insurance Companies
  • Insurance Companies that Go Above and Beyond
  • The Worst EAPs to Work With
  • Top Insurance Companies
Meet the Team!

Medical Credentialing Reviews
Credentialing.com Overall Rating: 5★★★★★ based on 35
5 1 35
reviews.
Credentialing.com

Convenient!

★★★★★

Navigating the credentialing process is time-consuming for a busy provider--especially one who is trying to bu...Read more

ild a practice. Credentialing.com reduces the workload and stress for the practitioner by putting a system in place to diligently apply to insurance panels and follow-up with each step of the credentialing process. The virtual basecamp is a convenient way to monitor communication and progress.

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- Heidi
Credentialing.com

Sophisticated Knowledge

★★★★★

The consultants at Credentialing.com had a sophisticated knowledge of my profession and completely owned the c...Read more

redentialing process from start to finish. They were responsive, easy to work with, and had a direct impact on the growth of my business and visibility as a psychoanalyst.

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- Margaret
Credentialing.com

Professional, efficient

★★★★★

As a busy child therapist, I did not have the time to navigate the credentialing process, so I contacted Crede...Read more

ntialing.com. They were professional, efficient, and were always available to answer my questions.

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- Denise
Credentialing.com

Time is money

★★★★★

Credentialing.com has been unbelievably convenient for my burgeoning practice. In a time where time is money, ...Read more

I am thrilled that I can focus on what's important, Best Practice, while Credentialing.com handles the unattractive, business aspect. Thank you! P.S. Laurie D. Is the best!

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- Weatherly
Credentialing.com

Effortless

★★★★★

Credentialing.com has been instrumental in expanding my private practice. They made the credentialing process ...Read more

effortless on my part. I was able to keep my focus on clients, instead of tedious paperwork.

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- Diana
Credentialing.com

Saved me days of work

★★★★★

Credentialing.com is amazing they have saved me DAYS of work by managing the inevitable headache of credential...Read more

ing. I have used them for several years and will continue to do so.

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- Malik
Credentialing.com

A Pleasure

★★★★★

I found working with Ashley at Credentialing.com a pleasure. She made the credentialing process simple and eas...Read more

y. She was quick to respond to any questions I had and remembered to keep me on my pre-determined schedule to get her all my documentation. I'm now on two panels and the whole process felt effortless. I highly recommend Credentialing.com!

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- Sandi
Credentialing.com

Easy

★★★★★

Credentialing with Credentialing.com was easy and the Credentialing.com staff I worked with were extremely hel...Read more

pful and friendly. I have recommended Credentialing.com to colleagues looking to get credentialed and will continue to do so.

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- Matthew
Credentialing.com

Best investment I made in years!

★★★★★

Always warm, friendly, and effective whenever I reached out to them, the Credentialing.com team took on the Go...Read more

liath of getting me credentialed. I'm trained as a psychotherapist and didn't have the know-how or time to trudge through the mess. DO contact them and save yourself the stress. The best investment I made in years!

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- Matthew
Credentialing.com

Wonderful experience

★★★★★

I had a wonderful experience with Credentialing.com. They were professional, efficient, and clear in their com...Read more

munication with me throughout the application process. Thanks to their help, I am now an in-network provider with most of my local PPO plans, and I get new insurance referrals every week.

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- Greg
Credentialing.com

Excellent job

★★★★★

Credentialing.com has done an excellent job handling the documentation and administration for my getting on se...Read more

veral insurance panels. Credentialing.com has saved me time and hassle freeing me to offer my professional services to clients.

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- Richard
Credentialing.com

Good Value

★★★★★

I was glad to work on Credentialing.com. The services provided were as described, were of good value and allow...Read more

ed me to attend to other aspects of building up my practice than following up with insurance panels. I've recommended them to colleagues.

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- Peter
Credentialing.com

Seamless

★★★★★

Thanks to Credentialing.com, I am now on three insurance panels and getting calls almost daily. Thank you Cred...Read more

entialing.com for your seamless assistance in helping me reach my goal of having a private practice. I don't think I could have done it without you!

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- Rachel
Credentialing.com

Highly Recommend

★★★★★

Credentialing.com team of professionals took the hassle and busy work out of the credentialing process so that...Read more

I could focus on doing what I do best. Thank you Credentialing.com... I highly recommend your services to other clinicians and medical providers.

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- Foster
Credentialing.com

Pleasurable Experience

★★★★☆

I did some of the paperwork for insurance credentialing in the past. I will never do that again! It is not a p...Read more

leasurable experience! I was so happy to find Thriveworks! They followed up with me and the insurance companies. No matter how long it took, they were professional and efficient and I was very satisfied with the results. I will always use Thriveworks!

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- Joseph
Credentialing.com

Investment

★★★★★

Credentialing.com came to my rescue and removed the anxiety and paperwork from the credentialing process. Now ...Read more

I have an ally and resource that I can depend on anytime I have a question or need assistance." But that pales in comparison to what I feel about your services. I am sorry I could not be more eloquent. I tell all of my colleagues about Credentialing.com - it is an investment well worth the results.

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- David
Credentialing.com

Great Resource

★★★★★

Credentialing.com has been a great resource in launching my practice. I know that they have helped me create a...Read more

professional footprint. THANKS, Credentialing.com!!!!

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- Dorothy
Credentialing.com

Burden off my shoulders

★★★★★

Opening a practice is very stressful and I wanted a credentialing company that could help take some of the hug...Read more

e paperwork burden off my shoulders. Thriveworks was the perfect choice! They were fast, efficient and professional answering all of my questions and making me feel confident and informed every step of the way. Thanks so much for all of your help!

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- Alison
Credentialing.com

Good communication

★★★★★

One thing I liked about Credentialing.com was good communication. The other was that I didn't have to think ab...Read more

out this part of the business. You're people asked for what they needed from me and took it from there.

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- Reid
Credentialing.com

Helpful

★★★★★

I have found Credentialing.com staff to be very helpful and efficient. Not only do they do all the work in con...Read more

tacting the insurance companies but they also are friendly and available when you call for an update.

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- Dennis
Credentialing.com

Thanks for your help!

★★★★★

Credentialing.com helped me become a provider with several insurance companies. The staff completed all paperw...Read more

ork, stayed in touch with me, responded within a reasonable time to my email questions, and when needed they followed up with the insurance company. Thanks for your help.

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- Roni
Credentialing.com

Wonderful

★★★★★

Since I first contacted Credentialing.com a year and a half ago, they have been professional, friendly, prompt...Read more

, and all-around wonderful!
I learned quickly why they were referred to me by other professionals they had assisted in credentialing.

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- Lisa
Credentialing.com

Worry Free!

★★★★★

Credentialing.com credentialing process is stress and worry FREE!! Your credentialing is completed by very fri...Read more

endly and helpful staff that will answer all of your questions or concerns promptly. I Felicia Perry LPC would highly recommend them for all of your credentialing needs. Community Behavioral Center LLC enjoyed doing business with Credentialing.com.

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- Community Behavioral
Credentialing.com

Quick and Friendly

★★★★★

Credentialing.com took care of all my credentialing needs. Their customer service was quick and friendly. I hi...Read more

ghly recommend Credentialing.com!

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- Kyle
Credentialing.com

Quality

★★★★★

I truly appreciate the quality of the professional services that I am receiving from Credentialing.com. Creden...Read more

tialing.com has me on the path to being credentialed with major behavioral health insurance companies!

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- Rod
Credentialing.com

Worth the money!

★★★★★

I used Credentialing.com to get credentialed with Medicare, Medicaid, and BCBS, and I knew I was in good hands...Read more

! They handled all of the work and communication with the insurances for me, and didn't stop until I got approved! DEFINITELY worth the money!

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- Emilee
Credentialing.com

Awesome

★★★★☆

Credentialing.com is awesome, as they were an essential step in my process of navigating the Credentialing ter...Read more

rain which was cumbersome and challenging without their expertise assistance.

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- Michael
Credentialing.com

Improved my bottom line

★★★★★

Using Credentialing.com for credentialing was a good decision for me. The service was convenient, timely, and ...Read more

user friendly. My rep was easy to contact and always there to help me out or answer my questions. And being paneled with insurance companies has improved my bottom line.

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- Cynthia
Credentialing.com

Painless

★★★★★

Credentialing through Credentialing.com was a seamless, painless, and efficient process. As a sole practitione...Read more

r with zero time for credentialing, Credentialing.com took the stress off, provided clear and timely updates, and allowed me to focus more on my practice and my clients. The time saved and the stress avoided are easily worth the investment. Thank you Credentialing.com!

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- Adam
Credentialing.com

Easy

★★★★★

Working with the Credentialing.com credentialing team was very easy and efficient. They kept me informed of my...Read more

credentialing status each step of the way, and were able to credential me with several companies of my choice. I highly recommend their services!

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- Tressa
Credentialing.com

Tremendous

★★★★★

I found out about Credentialing.com approximately three years ago and they have been a tremendous help to my b...Read more

usiness. I am a small company and need help to get on insurance panels and Credentialing.com did just that for me. The staff is courteous and efficient. I want to take this opportunity to thank them!

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- Denise
Credentialing.com

Hassle Free

★★★★★

Credentialing.com was instrumental in helping me start my private practice. They handled the entire process of...Read more

applying to be a provider on various insurance panels, and ultimately was accepted on each of these networks. Credentialing.com made this experience seamless and hassle free, allowing me to focus my energies and attention in my work with clients. The staff was professional, knowledgeable, and responsive to my inquiries/requests. I plan on continuing to utilize Credentialing.com as my practice grows. Thank you.

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- Ivy
Credentialing.com

Less confusing

★★★★★

Opening up a private practice is stressful enough. Credentialing.com made the credentialing process less stres...Read more

sful and less confusing. They kept me up to date throughout the credentialing process. Thanks Credentialing.com!

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- Tracy
Credentialing.com

Professional Quality

★★★★★

I was impressed with the professional quality of the organization. They kept me updated on the credentialing p...Read more

rocess and were very helpful in getting me on the panel. In fact, I plan on using them again right now to get on another insurance panel.

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- Les
Credentialing.com

Mr

★★★★★

Residential Care Facility for the elderly.

- Alex Hamilton

We would love to talk to you!

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