It would be incorrect to believe that once a healthcare provider is included in a payer’s network, the entire credentialing process is complete. To keep up compliance and deliver high-quality medical services to their clients, providers must go through regular screening and license authentication. We refer to this process of timely screening and authentication/verification as re-credentialing.

Re-credentialing is performed to validate a provider’s education and credentials and to alert medical professionals and organizations if fraudulent or exploitation activities are discovered. Going through the credentialing procedure is a difficult effort. It could take a lot of time and also be difficult. The expense of skipping the surgery, however, can be significantly greater.

Hospitals as well as other medical facilities are estimating revenue losses from prosecution, missed payments, and civil financial penalties in the hundreds of millions of dollars.

Now knowing that you’re aware of the significance of the re-credentialing procedure, we will go in-depth on it to ensure you are adequately educated.

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How Frequently Must a Health Provider Be Re-Credentialed?

State-by-state variations will be present in the answers to this query. The practitioner or providers must obtain credentials as soon as they are recruited in most American states.

They must then go through re-credentialing biannually after that. This regulation isn’t applicable in all states, though some, mandate that providers renew their credentials every two to three years.

Check the state laws and rules that apply to your health industry to determine the precise frequency of re-credentialing.

The First Condition for Re-Credentialing

First and primary, the hospital management is accountable for informing the nurses and physicians who report to them not less than sixty days before the deadline for re-credentialing.

All applications should be accessible to the providers online. Always be mindful that the re-credentialing procedure differs from jurisdiction to jurisdiction and can take a while to finish.

We suggest keeping the required records on file to speed up the procedure. Also, we advise creating institution criteria well in advance. Contact us here at 24/7 Medical Billing Services if the process seems too demanding to manage; our credentialing experts will be pleased to handle your re-credentialing process perfectly.

Information To Be Verified During Re-Credentialing

The traditional re-credentialing process involves the verification of the documents below:

  • State-issued licenses
  • Board accreditation/certification
  • Work history
  • Work experience
  • Penalties against Medicaid
  • Penalties against Medicare
  • Previous or recent history of malpractice
  • The National provider identification (NPI) number
  • State Penalties and Limits on Licensure and Restrictions on the Practice Field.

If a provider’s re-credentialing application is denied by the credentialing board, they are informed in writing along with an explanation of why. The opportunity to challenge a denial is available to providers. Within thirty days of being issued a denial mail, the provider must submit a written request for reassessment and reconsideration.

But, consulting with experts in the field of credentialing, such as the 24/7 Medical Billing Services, constitutes the sole surefire approach to ensure that you succeed with re-credentialing.

For many years, 24/7 Medical Billing Services has given credentialed provider enrollment assistance to medical institutions throughout the country. As a result, at the request of your healthcare institution, we have the expertise, capabilities, and knowledge required to manage the challenging credentialing process.

To learn further about our re-credentialing process and service, contact us right away at