Questions to Ask a Medical Credentialing Services

For some providers, medical credentialing is a mystery that is very hard to solve. Most practices see medical credentialing as a door that a large three-headed dragon guards, and they believe that this door is closed for everyone who wants to get in. Although it is an extreme portrayal of medical credentialing, it is undoubtedly a very daunting task. It is hard for medical care providers to get insurance panels on their own; outsourcing medical billing los angeles ca is what most practices go for! Many medical billing companies provide medical credentialing services. Read on to know what questions should be asked from medical credentialing services providers.

What is Medical Credentialing?

The process of providing your practice and individual information to Insurance companies is known as medical credentialing. This process enables the insurance companies to verify your NPI credentials and register your practice credentials, including Tax ID. In order to remain in-network with some insurance companies, the process of medical credentialing is mandatory. This process allows you to get paid for your practice’s healthcare services to patients from the insurance company whose plan they are using. 

How is Medical Credentialing done?

Medical credentialing is a process that involves filling out applications with the Insurance payer in order to provide them with the supporting documents. These documents enable them to verify your credentials in order to pay your practice for the services offered.  It should be noted that every insurance plan has a different medical credentialing process. Hence many healthcare practices go for outsourcing medical credentialing services. 

What is the importance of Medical Credentialing?

The medical credentialing process is essential. The reason behind it is that this process establishes the qualifications of a doctor or a team of doctors.  Credentialing of an individual or a practice implies that they have been deemed legitimate by a board of qualified personnel. Healthcare providers and physicians that are not credentialed are not allowed to work with insurance companies. Medical credentialing services are vital because it enables you to get access to in-network providers. This access will enable you to work with insurance companies. Outsourcing medical billing services help your practice to gain this access. 

How to Choose Medical Credentialing Services? 

No matter if you want to be credentialed individually or a credentialed practice, it is essential to choose the right medical credentialing services. This is because these services are responsible for making or breaking this complex process for you. Therefore, outsourcing medical billing services from a good company is very important. Here are a few things that should be considered while outsourcing medical credentialing services:

  • Flexibility
  • Reliability
  • Reviews
  • Experience
  • Technology
  • Cost

Questions to Ask a Credentialing Service

Choosing the exemplary medical credentialing service is like conducting interviews. It is the job of the medical billing company to convince their clients as to why one should choose them. Medical billing companies usually have their sales pitch ready, but this is not it! In order to select the medical credentialing service that suits your needs, you should always ask the right questions. Here are some of the questions that may help one to determine which outsourcing medical billing company is right for you:

The first question that is important to ask is whether the medical billing company provides the service of practice credentialing, individual credentialing, and organizational credentialing. This question helps you to determine what one is looking for. There are credentialing service providers specializing in practice credentialing, and if you need individual credentialing, this service provider may not be the one for you. Therefore outsourcing medical billing services also require some sort of research first. 

The second most important question is about the fees and claims percentages of the medical credentialing service. Being aware of any fees and costs is essential before agreeing to anything with a medical credentialing service. This question also helps you to realize how a medical credentialing service provider is upfront regarding their information. 

The next important question to ask from a medical credentialing service provider is how they keep organized during the credentialing process. This is because medical credentialing services include a complex process. This implies that there is a high chance of it getting messy. If services are not well organized, one can miss a deadline which will create problems. Ensure that the credentialing service provider has a system to track everything, including due dates. It is crucial to research and compare the software that the provider uses.  

The next question emerges from the last question that deals with the medical credentialing service providers’ kind of software. Although you may not know much about the software, you can always quickly scan it on google. Knowing the answer to this question enables you to see if the company uses updated technology and software. 

Another question that you must ask the medical credentialing service is whether their technology involves the use of smartphones. As nowadays, everybody uses their smartphones for performing various functions. If the company allows you to use your phone for submitting documents, receiving notifications and reminders, and signing papers, then the company you are working with is a good outsourcing medical billing company. 

The next vital question to ask a medical credentialing service is what is their review and negotiation process. The credentialing service provider is the one that is bound to negotiate new agreements that your practice is going to make with insurance companies. It is essential to find the one company that will choose the best offer instead of accepting the first. 

One more thing you should consider is asking for a reference for the company you desire to work with. Nowadays, most people require some sort of reference in order to opt for a new thing or a new service. The same goes for the credentialing service. Having some sort of references assures whether they have professional work experience or if they could be trusted or not. 


The process of insurance medical credentialing is complex as well as time-consuming. The healthcare providers who want to bill an insurance company via in-house medical billing and credentialing have to go through the strenuous process. This process needs a thorough understanding of documentation and regular follow-ups with Insurance companies. This makes medical credentialing a distraction that hinders the practice and patient care. But the good news is that by outsourcing medical billing services from companies like UControl Billing, the process of medical credentialing becomes easy. The medical credentialing services that UControl Billing provides include credentialing specializing in all the states, data gathering & CAQH enrollment, application submission & payer communication, medicare revalidations & yearly maintenance, and re-credentialing and demographic updates.