Is There A Difference Between Provider Enrollment & Credentialing?

Posted By Giovanna Stahl

Not many people are aware of the differences between medical provider enrollment and provider credentialing. ECLAT Health Solutions has worked with a number of healthcare facilities who require provider enrollment and credentialing assistance to ensure enrollment is completed effectively and fully, as well as making sure a providers’ background information is credible. If your facility or organization is looking to improve your medical billing processes, our experienced team of medical billing experts can ensure processes and providers align with your facility’s standards.

To help you distinguish between the two, we have provided more information below.

Medical Provider Enrollment

Provider enrollment, also known as payer enrollment, takes care of arranging medical providers and placing them onto insurance plans, networks, Medicare, and Medicaid so the provider can receive payment for the services offered to those to patients. The providers that are chosen to be enrolled with major health plans are considered to be “in-network”. Patients are able to receive more cost-saving services from in-network providers than out-of-network providers.

Medical Provider Credentialing

Health care providers are responsible for providing medical credentialing, which is a step-by-step process of obtaining a network between insurance companies. This is also referred to as “getting on an insurance panel”.

Medical credentialing is often provided by a range of health care specialists, such as chiropractors, therapists, counselors, and more. In addition to that, many health facilities are credentialed with major insurance companies since individuals who are in need of health care know that they can take their insurance to a facility that does accept it.

What’s the Credentialing Process?

In the beginning of the process, a healthcare facility must assess an insurance provider’s qualifications. Credentialing can take up to about six months, as the process requires a lengthy background check and may be completed through a centralized credentialing database, the Center for Affordable Quality Healthcare Inc (CAQH). CAQH provides an online database called the Universal Provider Database (UPD), which gathers information specifically for credentialing and makes it available to third-party payers. Our medical billing experts at ECLAT Health Solutions evaluate all insurance providers to ensure your patients are receiving the highest quality of services possible.

ECLAT Health Solutions: Quality Medical Billing Services

Partnering with reliable medical billing experts, such as ECLAT Health Solutions, will help pinpoint incompetent providers in the enrollment and credentialing process while preventing liabilities in malpractice suits. In order for a healthcare facility to avoid liabilities, credentialing and enrollment of their providers is highly recommended, as it will effectively manage and keep your providers up-to-date.

Let us help your facility get stay on track. Fill out our form to get in touch with our medical billing specialists!

Tags: Medical Billing, medical billing experts, medical billing services