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Provider Credentialing

What is Provider Credentialing?

Provider credentialing is a controlled method to assess the qualifications of specific categories of providers. This crucial safety check requires that providers such as doctors, dentists, and other allied healthcare professionals demonstrate that they have the required qualifications, training, and licenses to care for patients. Before a provider is accepted as an in-network provider, hospitals and health plans check the information provided by the provider.

The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) both mandate this credentialing process. Before a provider can be reimbursed by Medicare or Medicaid, CMS requires it. Furthermore, most hospitals pursue Joint Commission accreditation to indicate their dedication to providing high-quality care.



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