Recredentialing

Recredentialing refers to the process of re-verifying and re-evaluating the qualifications and practice history of a doctor or healthcare professional in conjunction with the client or healthcare insurer’s prevailing criteria.

Recredentialing is typically done once every 3 years to ensure that the doctor and healthcare professional continue to keep a clean record and stay updated regarding current medical trends and knowledge. Recredentialing may also involve other documents such as the doctor’s licenses, tax history, and financial background.

Why Is Recredentialing Important?

Recredentialing is important because it ensures that the most accurate information is available on the client or payer’s website so that patients have access to the right information for their medical services. Recredentialing is also part of the Health Plan quality management program to verify that qualified healthcare providers continue to be capable of meeting the healthcare needs of patients.

It also ensures that healthcare providers continue to participate in the Health Plan provider network and stay abreast of new medical technology. Recredentialing is an ongoing review process that assures patients and members of the public of the current competence of practitioners and healthcare providers. This is done by assessing and evaluating the competence and training of individual practitioners in particular specialty areas.

The level of review, therefore, helps to ascertain and verify that individual practitioners and healthcare providers possess the necessary qualifications, experience, training, and ongoing competence for the services they provide.

Who Needs Recredentialing Services?

Recredentialing services are mandatory for healthcare providers and practitioners who are part of an insurance panel such as the Medicare and Medicaid program. Practitioners and healthcare providers also need credentialing services to comply with specific state and federal healthcare requirements and the National Committee on Quality Assurance (NCQA).

Healthcare providers and practitioners who fail to update their credentials may be out of contract and removed from their insurer panel.

Why Choose KR Billing Solutions?

KR Billing Solutions can provide credentialing services. We have been providing credentialing services for various healthcare businesses and practitioners over the years and are a  proven and reliable partner to work with.

We will work together with you and your business to ensure that your credentials are updated and that the application process is efficient and fast. KR Billing Solutions can personalize and tailor our solution to fit your specific business needs. Let us do the credentialing service for you so that you can focus on your business and customers.

If you have any questions about recredentialing, you can call us at (855) 978-6499 or send us an email.