Medical Billing

In the tech dominated world of today, people turn to the internet for all their needs. They even choose a doctor for their medical needs by checking online for practitioners who have the best qualifications and are highly reviewed.

No wonder then that most medical practices are busy hiring experienced credentialing service firms to build their credentials and make them the most sought after doctors. However, this is not really as easy as it sounds. With a lot of professionals having opened shop to offer credentialing services, it is important that the medical practitioners choose the best service, which would deliver what it promises. Wondering how this can be done? Well, checking out a few pointers and asking a few relevant questions is all that is required. Let us find out more, here.


5 Considerations Before Hiring a Credentialing Service


  • Experience:

    The most important thing to look out for when hiring a credentialing service is the experience that they have in the arena. It would be a good idea to ask for references and cross check their work with the previous clients as this would be an added assurance of the credibility of the firm. Also experience in various medical arenas would mean that the service is well versed with all the regulations and requirements of credentialing.

  • Understanding of Fee Schedules and Claims:

    It is crucial that the credentialing service has a detailed understanding of the few schedule of the practice. They should also be able to answer queries about the percentage of claims that they would be able to recover from the well known insurance firms. In fact these elements should not be overlooked at all as these can be the deciding factor for the future of any medical practice.

  • Review and Negotiation of Agreements:

    Whenever a medical practice signs up with a new insurance company, it needs to sign an agreement. However when it comes to negotiating these agreements and reviewing them on a regular basis, this task falls on the credentialing service. Thus, before hiring a credentialing firm, it is important to understand what their approach towards these agreements is. Unless they are willing to negotiate and review agreements, they are of no use whatsoever.

  • KPIs:

    Checking out the KPIs i.e. the key performance indicators of a credentialing firm actually helps in zeroing in on the best credentialing service. The indicators that should be taken into consideration include the number of days it takes to enroll a provider, time taken to process an application and percentage of claim denials. Gauging these indicators is one of the sure shot ways to ensure if a service is good enough or not.

  • Technology Used:

    The world is ruled by technology which is why it is important that a credentialing service uses the latest software and techniques for its operations. A practitioner should ask relevant questions about the technology the credentialing service firm uses and how efficient this is? The answers to these questions would help in picking the best service.


Hiring a credentialing service for a healthcare practice is not easy. However, asking the right questions and gauging all the important parameters would help the doctors pick the best credentialing firm.


  1. I wanted to thank you for explaining some things to keep in mind when someone wants to hire a credentialing service. It’s good to know that you should understand what a firm’s approach is to agreements. I’m kind of interested if this is something the firm can give examples of, so you have a better idea of what you can expect from the agreements.

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