Blocks with healthcare icons are stacked in a pyramid and the blog title appears: New Year’s Resolutions for Providers & Practices

New Year’s Resolutions for Providers and Practices

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CredentialingOne Blog

New Year’s Resolutions for Providers and Practices

Posted on Friday, December 11, 2020

The year is coming to an end and it’s time to plan for a successful year ahead! Have you set any New Year’s resolutions for your practice?

These New Year’s resolutions for providers and practices can help you accomplish your goals in 2021 and beyond:

Blocks with healthcare icons are stacked in a pyramid and the blog title appears: New Year’s Resolutions for Providers & Practices

Set yourself up for credentialing, provider enrollment, and revenue cycle success with these New Year’s resolutions for providers and practices.

Conduct a Health Plan Audit


An annual health plan audit is critical to the success of your practice as it protects it from liability issues, boosts front desk collections, and helps keep providers from being deactivated by payers and having claims denied.

CredentialingOne offers a health plan audit service that determines whether your practice and providers are compliant with all your payers’ contracts and the insurance plans in which you’ve enrolled. For example:

  • Have you notified payers of a provider’s termination, resignation, or retirement within the timeframe required by the contract?
  • Have your providers opted in to any new plans added by a payer?
  • Have your providers opted out of any new plans added by a payer in which they do not wish to participate?

Start the year off right with a health plan audit to ensure your provider roster is current and all providers are participating in the correct plans.

Reduce Reimbursement Denials


In addition to an annual health plan audit, it’s essential to monitor your providers’ credentials throughout the year. Credentialing errors, such as expired certificates or missing CE credits, lead to reimbursement delays, denials, and underpayments.

Any time a provider or practice fails to accurately complete/update their credentialing, provider enrollment, or hospital privileging applications and documentation in a timely manner, they risk a significant loss in revenue. Unfortunately, this is all too common as the credentialing process is complex and it is very easy for items to fall through the cracks or to overlook important tasks like following up on applications.

Allowing a team of experts to handle all provider credentialing and provider enrollment work for you can help prevent claim denials and save you a lot of time and money down the road. CredentialingOne completes this work quickly and correctly, so that providers are credentialed and recredentialed with payers as soon as possible to avoid any breaks to the revenue stream.

Furthermore, we keep track of providers’ and practices’ expirables and our real-time, automated messaging alert system notifies you of any upcoming expiration dates so that you don’t miss a credentialing deadline that would result in denied claims.

A clock and stethoscope are shown and the following statistic appears: 8-10 hours per application is the average time it takes to credential one provider with one payer.

Outsource credentialing to improve work/life balance and prevent clinician burnout.

Improve Work/Life Balance


Clinician burnout is a major concern for providers and practices alike and is often the result of too much paperwork, administrative burdens, and working long hours.

Providers spend an alarming amount of time on EHR and desk work. On top of this, credentialing and provider enrollment are complicated, ongoing, and time-consuming processes that usually take longer and are more involved than the clinician expects. Completing just one application to credential a single provider with one payer takes about 8-10 hours; and most providers enroll in at least a dozen different health plans (each with its own unique application process).

Make preventing clinician burnout a top goal for your practice this year – outsource credentialing and give your providers more time to care for patients and their own well-being!


Keep Your New Year’s Resolutions with CredentialingOne


CredentialingOne can help you reach these goals and more. Contact us to learn more about our services, and start the credentialing process with us before the new year to take advantage of our end-of-year discount for qualifying customers!


By Stephanie Salmich

Do you know the difference between provider credentialing and provider enrollment?

What is the Difference Between Provider Credentialing and Provider Enrollment?

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CredentialingOne Blog

What is the Difference Between Provider Credentialing and Provider Enrollment?

Posted on Friday, June 12, 2020

Many healthcare professionals experience confusion over the terms provider credentialing and provider enrollment, and justifiably so – there is plenty of overlap between them. However, understanding the differences will help you better navigate the complex credentialing process.

What is Credentialing?

Credentialing is the process of verifying a provider’s qualifications for practicing medicine. The provider’s education, licenses, certifications, work history, references, and more are validated through primary source verification (checking with the original source that issued each credential). Additionally, background checks of the provider’s financial, criminal, and/or social media history may be conducted.

Credentialing is completed as part of the hiring process, in order to obtain hospital privileges, and as a key step in provider enrollment.

What is Provider Enrollment?

Provider enrollment is the process of adding a provider to commercial and/or government health plans so that the provider/practice can be reimbursed for services provided to patients.

To join a commercial health plan, the provider must follow the payer’s specific application and credentialing process. If the provider is approved and signs a contract with the health plan, the provider will be considered “in-network.” This is very exhaustive work, yet the credentialing process is even more strict and detailed for enrollment with government health plans like Medicare and Medicaid.

Most patients will not seek care from an out-of-network provider. Provider enrollment is therefore not only essential to getting paid but also for attracting patients.

Provider Credentialing Vs. Enrollment – What’s the Difference?

Credentialing and enrollment both entail similar tasks related to the verification of a provider’s credentials, and credentialing is a part of provider enrollment. You can think of credentialing as an umbrella term used to encompass all instances where validating a provider’s qualifications is necessary – for the purpose of attaining employment, hospital appointment, and/or participation in health plans.

Because credentialing is a condition of hiring, granting hospital privileges, and contracting with payers, the work involved becomes very repetitive and laborious as each entity (the practice, hospital(s), and payers), must ensure the provider is qualified.

There is even more redundancy when you factor in the lack of standardization among health plans. Each payer has its own unique credentialing requirements and most providers will enroll in a dozen or more different health plans in order to remain competitive. This equates to a lot of time and paperwork – the average time it takes to credential one provider with one payer is 8 to 10 hours per application.

The repetition only continues as providers must renew their appointment with a hospital (usually every two years) and complete periodic recredentialing with commercial insurance companies and revalidation with government payers.

Outsourcing Credentialing and Enrollment


CredentialingOne can take care of this redundant and time-consuming work for you.

We handle everything – from completing documentation and submitting applications, to following up on them until each provider has an effective start date with each payer, to the ongoing credentialing maintenance needed to keep payers and practices compliant with health plans.

Our services include credentialing for all provider types and new/existing practices of any size, provider enrollment in commercial and government health plans, recredentialing/revalidation, hospital appointment and reappointment, and much more.

Additionally, we provide monthly monitoring and maintenance of documents, certifications, CE, and malpractice insurance, as well as automated alerts to ensure you never become inactive with a payer as a result of credentialing noncompliance.


To schedule a complimentary consultation on how we can help you with provider credentialing and provider enrollment, contact us today.


By Stephanie Salmich

An emergency sign outside a hospital is shown, along with the blog title: COVID-19 Resources for Provider Privileging During a National Health Emergency.

COVID-19: Resources for Provider Privileging During a National Health Emergency

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CredentialingOne Blog

COVID-19: Resources for Provider Privileging During a

National Health Emergency

Posted on Monday, March 30, 2020

An infographic outlining different providers hospitals may call upon to help during the coronavirus crisis, which notes that many regulations are temporarily changed for provider privileging during a national health emergency.During a national health emergency such as that caused by the coronavirus, many facilities experience a provider shortage.

To combat COVID-19, you may need to expand your team of healthcare professionals by relying more heavily upon retired and volunteer providers, part-time clinicians, practitioners from other states, practitioners from other departments, and telehealth.

Provider Privileging During a National Health Emergency

During a health crisis, hospitals strive to grant privileges to these clinicians as quickly as possible while still protecting patients by providing them with qualified practitioners.

The federal and state governments, along with other regulatory entities, are temporarily adjusting some licensing and privileging requirements to accommodate the greater need for more providers and access to care due to COVID-19.

CredentialingOne can help you navigate any new and/or temporary rules and ensure your patients receive safe care from competent providers.


To start, we’ve compiled a list of resources to consult regarding provider privileging during a national health emergency:


An emergency sign outside a hospital is shown, along with the blog title: COVID-19 Resources for Provider Privileging During a National Health Emergency.

Many regulations are temporarily changed for provider privileging during a national health emergency.

1135 Waivers – the U.S. Department of Health & Human Services (HHS) is authorized to issue waivers during the COVID-19 national emergency. You can find information on blanket waivers and how to apply for individual waivers here. You must send individual waiver requests to your CMS Regional Office, and office email addresses can be found here.

Disaster PrivilegesThe Joint Commission has posted requirements for privileging, re-privileging/re-appointment, and telehealth privileging during a disaster.

Medicare Provider Enrollment – the Centers for Medicare & Medicaid Services (CMS) is offering new flexibilities regarding Medicare provider enrollment, including waiving certain screening requirements, allowing licensed providers to perform services outside their state of enrollment, and expediting applications; see its FAQs.

Medicare Telehealth CMS has expanded Medicare telehealth to include a wider scope of services so that more patients can access care from home; see its FAQs and Fact Sheet.

States Waiving Licensure Requirements/Renewals – the Federation of State Medical Boards (FSMB) created this table along with links to the original sources declaring the changes in response to the coronavirus.

States Expediting Licensure for Inactive/Retired Licensees – the FSMB created this table, which includes links to states’ resource pages.

The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) this program verifies registered healthcare volunteers’ credentials in advance, so they can respond more quickly to help in a crisis. (Hospitals should check with their insurance companies to determine how volunteer providers may/may not be covered by their malpractice insurance.)

For additional information, you can also contact your specific state medical association.


These resources may be updated as the COVID-19 situation progresses.

If you need further guidance on provider privileging during a national health emergency, please contact us – we’re here to help.


By Stephanie Salmich