Facility Credentialing (Updated)

For healthcare providers across the country, getting credentialed with insurance companies can be a daunting and arduous process. However, facility credentialing makes individual provider credentialing look like child’s play.

(Our credentialing specialists can help! Call us at 1-855-664-5154  .

What is Facility Credentialing?

Facility credentialing is the process by which a health plan (insurance company) evaluates and then approves a facility to be “in network” with the health plan, and a participating provider of specific healthcare services. Don’t confuse a “facility” with a “group practice.” A group practice has a different, and much simpler, credentialing process.

To complete the process, your facility must complete and submit a variety of forms including a facility credentialing application, as well as other documentation like the applicant’s education, experience, licensure, certifications, accreditation, and more.

What Types of Facilities Can be Credentialed?

To be credentialed as a facility, a healthcare organization will need to meet various and numerous standards, which often including a JCAHO certification, CARP certification, or an equivalent. The type of organizations eligible for facility credentialing often include:

  • Hospitals
  • Home Health Agencies
  • Freestanding Surgicenters
  • Sleep Medicine Centers and Labs
  • Skilled Nursing Facilities
  • Community Mental Health Centers
  • Hospice Centers
  • Ambulance
  • Birthing Center
  • Clinical Lab
  • DME
  • Freestanding Radiology Center
  • IV Infusion Therapy
  • Portable X-Ray
  • Cardiac Lab
  • Outpatient Diabetes Management
  • End Stage Renal Disease Providers
  • Orthotic/Prosthetic Supplier
  • PET Center
  • Pharmacy
  • Dialysis Center
  • Residential Treatment Center
  • Rural Health Clinic (RHC)/Federally Qualified Healthcare Center (FQHC)
  • Comprehensive Outpatient Rehabilitation Facility (CORF)

When Should a Facility Begin the Credentialing Process?

A facility should begin the credentialing process at least 120 days prior to when they wish to accept 3rd party payments (that is, payment from insurance companies).

Let Us Help You With Credentialing

Guess what? You can avoid all of the headaches and the frustration that come with the credentialing process. How? You can hire a team of individuals who are experts when it comes to credentialing. Our credentialing specialists have the education, the training, the experience, and the knowledge needed to get you on insurance panels. They know exactly how to get the job done—you just have to let them do it! To hear more about our services, just give us a call at 1-855-664-5154 and we’ll be happy to answer any questions. We’re excited to hear from you and to assist you in the credentialing process.