What are the Major Differences between the Provider Enrollment and the Credentialing Services?

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The medical industry has transformed and there are several new additions in the practice which has made it much more efficient. Provider enrolment and credentialing services have become an important part of the process and every practitioner need to perform it to continue in the field. Credentialing specialists have made the life of clinicians easy as they take over the task of the entire administrative process which requires several applications and continuous follow-ups.

Many people have the misconception that Provider enrolment and credentialing is the same thing. However, this is not true. Even though both are inter-linked and inter-related, but there are certain differences between credentialing services and provider enrolment.

What is provider enrolment?

Provider enrolment is the process of getting on the panel of the insurance networks, plans, Medicare and Medicaid. Most patients like to be treated by the clinicians registered with the insurance companies so that they can avoid out-of-network charges. To get the insurance claims, the medical practitioners must be enrolled with the insurance company. Separate applications are filed with the leading insurance companies requesting them to empanel the practitioners for a smooth practise and revenue cycle.

What are credentialing services?

The credentialing process begins after you apply to get enrolled. The insurance companies verify the information of the medical practitioners including their education, career, experience, licences etc. It is the process of authenticating the clinicians by verifying their records. It is done by contacting the primary sources of the degrees and licenses to make sure that there is nothing wrong. Credentialing is not a one-time process. The medical practitioners need to be re-credentialed after every 3-5 years so that the records are always accurate and up-to-date. It helps the patients in placing their trust in the doctors and to get the best treatment.

Difference between provider enrolment and credentialing Provider enrolment is about getting enrolled with the insurance companies for effective revenue cycle and credentialing is about getting the records, licences and degrees verified so that the patients can trust the practitioners and get treated. Enrolment cannot be done without proper credentialing of the clinicians. Credentialing takes almost 90 days and the enrolment happens only after the records are credentialed.

HRX can help!

Both processes are important for survival in the medical industry. They need to be performed properly and embraced by all the practitioners to continue seeing the patients and get paid for their services. However, provider enrolment and credentialing services are very time taking and complicated because of which it is better to get them done through experts. HRX can prove to be highly useful as it provides efficient staff which has considerable experience and knowledge about provider enrolment and credentialing services.

Complete and accurate data must be provided to the insurance companies and constant follow-ups are also essential. The Medical credentialing specialists and payer enrolment experts of HRX can take away a huge administrative burden from your shoulders and you can just concentrate on providing excellent medical services.

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