What is “credentialing” in medical billing?

Credentialing in Medical Billing

Credentialing is the process by which healthcare providers are verified and authorized to participate in a healthcare network or accept insurance reimbursement.

Credentialing in Medical Billing Explained

In medical billing, credentialing ensures that a healthcare provider meets the necessary standards and qualifications to treat patients and be reimbursed by insurance companies. This process typically involves verifying the provider’s education, certifications, and professional experience.

For example, a hospital completes credentialing for a new physician to ensure they can bill insurance companies for patient services.

Learn more about common acronyms and abbreviations in Medical billing glossary.

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