Credentialing

Did you know that Medical Credentialing dates back to Persia in 1000 B.C.? To qualify for a medical license, a physician had to treat three criminals, if everyone lived, then the physician was qualified to practice medicine for the rest of his life. (Care Cloud, 2019) Thank goodness the laws around credentialing have changed drastically over the years! However, the idea behind credentialing is relatively the same, to ensure doctors have the necessary experience to safely and effectively practice medicine. Credentialing is not only important to protect patients, it is essential for reimbursement.


Unlike the days in Persia, much of our credentialing now is focused on payer participation and not just provider capabilities and qualifications. In most cases partnering with insurance carriers is a necessary process for financial success. Unfortunately, payer credentialing is anything but quick and easy. National credentialing timeframe averages range from 60-90 days assuming all of the information is accurate in the initial application. If there is a petition process, lobbying, or appealing, then it can take between 190-220 business days. According to one study, up to 85% of credentialing applications are incomplete/incorrect the first time. (Modio Health , 2016) Based on the Medicare Fee Schedule approximately $650 per provider is lost daily, if the provider is not credentialed properly. Given these statistics, what financial impact could this have to your organization?


Much of the problem behind accurate credentialing is time and attention to detail. Office managers are inundated with tasks, phone calls, emails, schedules, physicians, and patients, unable to concentrate solely on credentialing and the burden it can become.


As a trusted resource in the industry, let Lighthouse Healthcare Advisors support your payer credentialing process with timely and accurate applications.


Let us help you with:

• Provider Enrollment and Credentialing

• Medicare Revalidation

• NPI Registration

• CAQH Registration and Maintenance

• Completion of all Applications and Necessary Paperwork

• Maintenance of Delegated Credentialing Worksheets by Payer

• Maintenance of Credentialing Status Master File

• Continuous Follow Up with Each Payer and Ongoing Status Updates


We are confident that we can:

• Decrease your Compliance Risk

• Standardize your process for provider onboarding

• Increase provider satisfaction and education

• Enhance revenue opportunity because of consistent contract monitoring




Care Cloud. (2019). What is Medical Credentialing? Retrieved from Continuum: https://www.carecloud.com/continuum/what-is-medical-credentialing/


Modio Health . (2016, 07 12). Uncovering the True Cost of Medical Crednetialing . Retrieved from Modio: https://www.modiohealth.com/life/credentialing/medical-credentialing-cost



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