Journal of Urgent Care Medicine

Credentialing: The Gatekeeper of Access and Reimbursement

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC In the healthcare ecosystem, credentialing is more than a bureaucratic hurdle—it’s the linchpin of successful revenue cycle management. For urgent care centers, credentialing determines whether providers can be reimbursed for the care they deliver to insured patients and whether they can participate in insurer networks. Credentialing is the formal process by which payers—commercial insurance companies, Medicare, and Medicaid—verify the qualifications, training, licensure, and work history of care providers. …

Credentialing: Why Should I Hire a Professional?

In the words of Red Adair, “If you think it’s expensive to hire a professional to do the job, wait until you hire an amateur.” Credentialing dictates how you bill. Do I bill as a group? Should I credential my nonphysician practitioners (NPP)? Which place of service (POS) should I bill with based on my contract? These are all important questions. Did you know that in April of this year, an urgent care chain reached …

Beware of Urgent Care Contract Clauses on Offshore Vendors, Other Issues

URGENT MESSAGE: As payers introduce new clauses into urgent care-specific contracts, urgent care operators need to be vigilant to how several changes may affect their day-to-day operations. Kelly Mattingly is Director of Contracting & Credentialing at Practice Velocity, LLC, and a contracting and credentialing consultant with Urgent Care Consultants. With each new clause, provider contracts offered by payers become more complex, adding a host of burdens to the day-to-day operations of the urgent care center—eg, …

Due Diligence is Critical When It Comes to Credentialing

Credentialing is a process used to evaluate the qualifications and practice history of a doctor, including a review of completed education, training, residency, and licenses. It also includes any certifications issued by a board in the doctor’s area of specialty. Many urgent care centers assume their providers are fully credentialed; however, it is advisable to do your due diligence when engaging a new physician to ensure he or she has the necessary credentials. Even if …

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