Physician Credentialling

Physician Credentialling is the process of providers getting themselves enrolled with the insurance companies to be able to see their members. It is an important first step for any physician before they start their own practice or join a new practice. The process to enroll varies depending on the payor and involves submitting physician credentials including degrees, licenses and certifications and any adverse events that may have occurred while the physician was practicing.

Most commercial insurances now use CAQH (Council for Affordable Quality Healthcare) for document and data sharing, while Medicare has its own portal, many state Medicaid plans still need paper submissions for credentialling. After credentialling is complete, payors also require the physician to keep their information up to date and also do regular recredentialling every few years.

Benefits of outsourcing with Finch

• Finch has extensive experience in the credentialling process with all payors including the BlueCross BlueShield plans, Commercial Insurances, and Medicare and Medicaid plans.
• Finch has a proprietary credentialling software that keeps track of the process end to end.
• Physicians get regular updates thru emails as well as phone calls about the process and the status of their applications.