Credentialing Process Overview

Credentialing is a critical component of healthcare operations—ensuring that providers are properly enrolled with insurance payers and authorized to deliver reimbursable care. At PractiCons, we offer a fully managed credentialing solution built around a clear, step-by-step process that reduces errors, accelerates approvals, and prevents missed deadlines.

Whether you’re undergoing initial credentialing or recredentialing, our team manages the entire process for you—so your staff can focus on patient care, not paperwork.

Our Standard Credentialing Workflow Includes:

• Completing all initial and re-credentialing applications

• Submitting applications with tracking numbers to each payer

• Consistent follow-up to confirm receipt and progress

• Regular communication with payers throughout the process

• Scheduled reporting to clients at preferred intervals

• Immediate notification upon confirmation of participation or privileges

By outsourcing your credentialing to PractiCons, you ensure every deadline is met, every form is complete, and every payer update is tracked—without burdening your internal team.

Health Plan Credentialing: Step-by-Step

Here’s a general breakdown of what happens during the health plan credentialing process:

Step 1: Gather required documents and data from the provider

Step 2: Submit credentialing applications to selected payers

Step 3: Payers conduct primary source verification of:

• State license, DEA, CDS

• Education and postgraduate training

• Hospital privileges

• Malpractice insurance and claim history (5–10 years)

• Work history and any Medicare/Medicaid sanctions

Step 4: Payer’s credentialing committee reviews and approves

Step 5: Some payers may conduct on-site facility visits

Step 6: Provider and TIN are added to the plan’s system

Step 7: Provider is officially enrolled and can start billing

By partnering with PractiCons, you gain a team that understands the complexity of credentialing and ensures no detail is missed. Let us guide your practice through each step, delivering faster approvals and uninterrupted reimbursements.