Credentialing & Contracting


Credentialing & Contracting

Larger Reimbursements, New Patients

Each managed care organization (HMO/PPO) sets its own qualifications and then structures its process to ensure that the providers meet these qualifications. Once credentialed, a provider must be re-credentialed at least every three years to comply with federal and state regulations, which govern MCO’s operations. This includes Medicare and Medicaid.

Credentialing is critical for optimizing your revenue cycle. Our Credentialing Specialists at Physicians Billing RX can navigate you through the process toward getting your applications approved by as many MCOs you would like to become members of.

Credentialing Requirements

  •     License to practice
  •     Drug Enforcement Administration (DEA) or Controlled Dangerous Substances (CDS) certification
  •     Education & training
  •     Work history
  •     Board certification
  •     Professional liability claims settlement history
  •     Sanctions, restrictions or limitations in scope of practice, as defined by the State Board of Medical Examiners or licensing agencies
  •     Medicare and Medicaid sanctions
  •     Application with attestation

Typically applications are processed within 30 days, but some applications can take over 90 days to be approved. Because of this lag time, you should start your Credentialing process with us now.