Credentialing is vital for patient safety, quality care, and compliance in healthcare. However, managing credentialing tasks can be challenging and time-consuming, which is why so many healthcare organizations seek help from medical credentialing companies.
This guide will examine the best medical credentialing companies to provide healthcare services with credentialing.
Azulity’s provider credentialing services can help you achieve your goals by streamlining your healthcare credentialing workflow for better efficiency and accuracy.
Importance of Medical Credentialing
1. Builds Patient Trust
Patients’ mental state significantly affects their recovery. Those who trust their healthcare providers report less anxiety and an overall better experience. When a patient’s physician has fully credentialed staff, they’ll feel more confident in their care. That’s because they’ll understand that the team caring for them is qualified and capable of providing the treatment needed.
Furthermore, having fully medically credentialed nurses and doctors makes your organization more appealing to other employees, from new physicians, PAs, LVNs, RNs, nurse practitioners, and the support staff. They’ll want the prestige that comes from knowing colleagues are all well-trained and up to speed on the latest in the medical industry. You encourage future excellence by highlighting the current outstanding abilities of your team.
2. Demonstrates Your Professionalism
In healthcare, showing professionalism with hard documentation is very much in your best interest. Taking the time to fill out paperwork required to show your credentials is a small price to pay for assuring patients of your bona fides. Healthcare Innovation noted, “Through a standardized process involving data collection, primary source verification and committee review by health plans, hospitals and other healthcare agencies, patients are assured of their healthcare professional’s merit and experience.”
In the past, medical professionals may have balked at credentialing because of all the paperwork they’d have to wade through. However, modern methods allow much of this information to be handled online. Check that your team can use electronic credentialing for any entities that want to check your standing, such as before you start a contract with another organization or before any hospital can allow you to become an affiliate.
Details to provide include where you went to medical school, the location of your internship or residency, your board certifications, and your curriculum vitae. Of course, you’ll also note information about my malpractice insurance and your current, valid medical license.
3. Required for Compensation
You’ll need to be medically credentialed, as this is required for reimbursement from insurance companies. Getting the documentation finished promptly ensures that a new nurse or doctor I’ve hired can begin providing services on hiring day. To that end, many organizations will require applicants to have their documentation set up well beforehand.
It’s not a task to put off, and the timeframe can vary from state to state because of differences in regulations and credentialing laws. Private health insurance companies like Medicare and Medicaid will want proof of medical credentialing before allowing your staff to engage with patients.
4. Cuts Down on Medical Errors
When healthcare professionals obtain proper medical credentials, it helps to support the safety and security of the entire industry. Medical errors are implicated in 98,000 deaths in America (per Healthcare Innovation’s report), making the importance of medical credentialing clearer. Patients have a right to trust that their healthcare providers know what they’re doing and are working in a safe and approved fashion.
5. Ensures You Have Adequate Staff Levels
Medical credentialing is essential to filling out your team if you’ve been having problems maintaining the requisite staff levels to serve your local community. New medical staff candidates who aren’t coming from a job placement company (that would help them with credentialing) should get started with medical credentialing as early as possible.
It could take as many as four months to complete. To help pave the way, create resources such as a credentialing packet to give to all new hires. It will support them through the application process. Your human resources department would be well advised to track all candidates’ medical credentialing status and identify any obstacles that could delay onboarding new hires.
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Types of Medical Credentialing
1. Professional Credentialing: Ensuring Individual Competence and Compliance
Professional credentialing concentrates on assessing the qualifications and background of individual healthcare providers to ensure competence and compliance. This credentialing typically involves verifying educational backgrounds, licenses, certifications, and training programs completed by the provider.
Professional credentialing also includes evaluating work experience, references, and professional affiliations. This process ensures that healthcare professionals have met the necessary educational and training requirements to practice in their respective fields and deliver quality patient care.
2. Facility Credentialing: Evaluating Healthcare Organizations
Facility credentialing focuses on evaluating healthcare facilities, such as hospitals, clinics, and ambulatory surgical centers. This type of credentialing assesses the facility’s compliance with regulatory and accreditation standards, including proper licensing, facility policies and procedures, quality assurance programs, and patient safety measures. Facility credentialing is essential for healthcare organizations to participate in insurance networks and provide patient services.
3. Payer Enrollment Credentialing: Enrolling Providers in Insurance Networks
Payer enrollment credentialing focuses on enrolling healthcare providers and facilities in insurance networks. It involves submitting the necessary applications, forms, and documentation to insurance companies and payers for participation in their networks. Payer enrollment credentialing ensures that providers can bill and receive payment for their services to patients covered by specific insurance plans.
Azulity specializes in healthcare master data management and provider credentialing services, bringing proven expertise in implementing healthcare data solutions and credentialing across the US. Our comprehensive platform ensures consistent patient, provider, location, and claims data synchronization across all systems and departments.
Key features include: healthcare MDM, provider MDM, reference data management, credentialing, and provider enrollment. We serve healthcare technology leaders – from CIOs and CDOs to VPs of data platforms and credentialing – helping them eliminate the costly problems of fragmented data systems. Book a call to learn more about our healthcare master data management services today!
15 Best Medical Credentialing Companies
1. Azulity: The Experts in Data Synchronization for Credentialing
Azulity specializes in healthcare master data management and provider credentialing services, with proven expertise in implementing healthcare data solutions and credentialing across the US. Their comprehensive platform ensures consistent patient, provider, location, and claims data synchronization across all systems and departments.
Key features include: healthcare MDM, provider MDM, reference data management, credentialing, and provider enrollment. Azulity serves healthcare technology leaders – from CIOs and CDOs to VPs of data platforms and credentialing – helping them eliminate the costly problems of fragmented data systems.
2. MediBillMD: A Leader in Physician Credentialing
Headquartered in Dallas, Texas, MediBillMD is one of the best medical credentialing companies for physicians and healthcare practices. It offers tailored medical credentialing services across 45+ specialties. The company only charges a small percentage of your monthly collections for its proven credentialing solutions.
Its experienced team rigorously follows each process step, from information gathering to contract negotiation, to ensure its clients join the networks of the nation’s top-ranking insurance payers, such as Medicare, Medicaid, UnitedHealth, Cigna, and more. MediBillMD is HIPAA-compliant and ISO-certified.
Its medical credentialing team follows all the regulatory standards to safeguard your personal information and ensure top quality. You can schedule a free consultation with a MediBillMD credentialing specialist to understand the process for enrolling in an insurance network.
3. Practolytics: A Revenue Cycle Management Firm Excelling in Credentialing
Having perfected the revenue management cycle for healthcare practitioners, Practolytics is also making its mark on the list of top medical credentialing companies. The company specializes in 28 different healthcare niches and has 20+ years of experience in the IT industry, providing transformational solutions for its clients.
You can partner with Practolytics at any stage of your credentialing application. It can involve initiating your credentialing process, CAQH verifications, and re-credentialing with insurance programs. Practolytics has it all covered. Practolytics also helps you add or remove a partner, as well as Medicare re-validation and Medicaid re-enrollments, hospital privileges, and more.
4. Birkham Healthcare: A Revenue Cycle Management Firm That Excels in Credentialing
Bikham Healthcare is a New York-based revenue cycle management (RCM) firm offering a range of medical billing and coding services to over 500 clients in the USA. The company was formed in 2006 and has expanded to 4 global offices, 150+ employees, and 15+ specialties. Now, it is an established leader in laboratory billing services.
Their medical credentialing services include network research, application filing/ follow-up, appeals for closed networks, information updates, annual credentialing, and maintenance of PECOS and CAQH profiles.
With Bikham Healthcare, you get credentialed by private and government insurance payers in no time. Some of the payers they target include Medicare, Tricare, Aetna, Kaiser Permanente, and Wellcare. You can contact them to inquire about their “fixed price per application”.
5. Verisys: Leading the Industry in Compliance
Verisys is a medical credentialing company in the U.S. that has the most trusted clients. Their provider credentialing services reflect not only compliance but also actual information. With the expertise of the Verisys industry, multiple sources of provider credentials are vetted so you will meet all the standards.
6. Neolytix: Remote Credentialing Support for Practices and MSOs
Represented by its cute mascot Doctopus, Neolytix offers remote non-clinical support to private healthcare practices and physicians. It positions itself as the No.1 management services organization (MSO) solutions provider for healthcare organizations. Neolytix, operating from Chicago, Illinois, excels at medical credentialing and enrollment.
It handles information verification, application filing, payer contract negotiation, real-time updates, and re-credentialing on behalf of its clients. Its advanced provider onboarding portal, inCredibly™, streamlines the enlisting process for large healthcare organizations and offers innovative solutions like secure cloud storage, automatic status updates, expiration alerts, form library, etc. You can visit their website to request a free quote and explore their physician credentialing services across 16 specialties.
7. nCred: Exclusively Focused on Medical Credentialing
nCred’s distinguishing feature among other medical credentialing companies is its exclusive proficiency in medical credentialing services. The company began operations in 2011 as a group of medical practice management professionals. Based on their past credentialing experience, they grew the organization and specialized in payer-provider enrollment for medical practitioners with varying specialties.
nCred has been included in the list of the foremost medical credentialing and billing companies for 2025, attributed to its impressive record of serving 5,200 providers and processing 61,000 applications. Additionally, it has achieved the remarkable feat of serving all states within the United States and accommodating the maximum number of health plans. nCred also offers provider enrollment, CAQH, Medical license renewals, credential verification, and more.
8. VerityStream: Credentialing Solutions for Healthcare Organizations
The central area of focus for VerityStream is complete credentialing solutions that are directly integrated within health care systems. Its solution provides an auto-verified primary source and continuous monitoring. What sets them apart: Cloud-based credentialing platform, Advanced analytics, and reporting integration with major EMR systems
9. Capline Healthcare Management: Credentialing and Revenue Cycle Management
Capline Healthcare Management is an A+ rated, accredited business by the Better Business Bureau. Therefore, it is worth mentioning in our top credentialing companies list. The company was founded in 2016 in Houston, Texas. Since then, it has managed the revenue cycles of more than 650 clients, helping them achieve near-zero denials in the cut-throat healthcare sector.
Capline’s medical credentialing solutions range from Health Maintenance Organization (HMO)/ Preferred Provider Organization (PPO)/ Medicare credentialing to fee negotiation and re-credentialing. And services like demographic updates and insurance portal creation are included in the price. You can browse their website for more details on their credentialing process or contact a specialist for a free consultation.
10. CureMD: Practice Management Solutions That Include Credentialing
While CureMD is not a medical credentialing company in the traditional sense, its practice management ecosystem does help streamline the complex provider credentialing process. CureMD is a well-known organization that provides medical billing and credentialing services. Based in New York, it has been in the health IT industry since 1997.
It specializes in EHRs and advanced medical billing practices. Moreover, CureMD has won multiple accolades, including top EMR and customer success awards. We have included CureMD in the list due to its years of experience serving 30,000 practices since its inception. Furthermore, they offer a comprehensive set of features beyond credentialing, thus facilitating your ideal healthcare practice.
11. Billing Advantage: Medical Billing for Credentialing Efficiency
Right from the southwestern tip of North Reading, Massachusetts, Billing Advantage delivers medical billing excellence to over 300 clinicians in 22 states. The company was formed in 2004 and employs billers and coders with more than 20 years of experience in the field.
Under the umbrella of medical credentialing, Billing Advantage manages hospital credentialing, insurance credentialing, doctor credentialing, and mental health credentialing. Physicians from various specialties can apply for in-network partnerships with HMOs, PPOs, Medicare, and Medicaid to collect service reimbursements.
12. Symplr: Provider Credentialing Services and Compliance
Symplr is one of the key healthcare players in the industry, offering diversified healthcare technological solutions, including provider credentialing services. They adhere to regulations and always meet the terms for credentialing as required in the industry. Why Choose Symplr? It offers a user-friendly platform for credentialing and compliance, focusing on regulatory compliance and minimizing credentialing risks.
13. Physician Practice Specialists: A Medical Credentialing Focus
Trusted by Athenahealth and AdvancedMD, Physician Practice Specialists (PPS) is bringing about real change in healthcare consultancy. Unlike other medical billing and coding companies, PPS focuses on medical credentialing, consulting, and start-up services. It is rated the ‘best credentialing company’, embodying the Floridian spirit, and is 100% US-based. PPS was formed in 2008 as a nationwide medical credentialing, contract negotiation, and start-up consulting services provider.
Since then, it has managed the applications of over 1 million physicians and helped them get credentialed with government and private payers. As a credentialing specialist, PPS offers an à la carte of credentialing services, ranging from insurance credentialing to hospital enrollment and CAQH credentialing to medical licensing. You can even explore their cutting-edge credentialing software for application completion, submission, and tracking.
14. IntelliSoft Group: Credentialing and Provider Data Management Experts
Another well-known medical credentialing company is IntelliSoft Group, which specializes in credentialing and provider data management. Their cloud-based credentialing software is built for efficiency and accuracy, keeping all healthcare organizations’ credentialing tasks in one place. Why Choose IntelliSoft Group? The cloud-based platform enables easy access and management of credentials and reduces administrative burdens with automated processes.
15. Practice Worx: Credentialing for Diverse Healthcare Providers
It seems like the Sunshine State’s specialty is physician credentialing. PracticeWorx is another company from central Florida that focuses solely on medical credentialing. They are “insurance enrollment and credentialing experts for healthcare providers”. Their services are available nationwide, and some prominent insurance payers with which they enlist providers include Aetna, Blue Shield, MetLife, Coventry, UnitedHealthcare, and Anthem BCBS.
PracticeWorx offers insurance credentialing services to physicians, dentists, allied health professionals, occupational therapists, behavioral health experts, and lab technicians. Their comprehensive credentialing process includes verifying documents (licenses, certifications, personal records, resumes, affiliation letters, etc.), managing credentials (demographic updates, courses completed, credits earned, license renewals, etc.), and completing and submitting applications.
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How to Choose the Best Medical Credentialing Company
1. Practical Experience: Why It Matters in Medical Credentialing
Experience says a lot about a company, especially when choosing the best physician credentialing company. It influences nearly all the other qualities of a credentialing service. More practical experience refines the company’s methods, bringing out the most efficient practices.
More years of experience show that the company has successfully satisfied its clients over the years and managed to survive among tough competitors. This also defines the company’s hard work and determination. Moreover, a vast portfolio clarifies the credentialing company’s strengths and weaknesses, making decision-making easier.
2. Technical Capabilities: What to Look For
Technical capabilities are as important as knowledge and skills gained from experience in analyzing a credentialing company. Other than techniques and methods, it includes the tools the company relies on to complete its objectives. In this case, the software systems a company depends on matter the most.
A good medical credentialing service would be equipped with the latest software systems. These software systems would ensure data security, smooth process completion, and user-friendly interfaces. Top services use the best credentialing software systems, such as cloud-based systems, which can be accessed remotely and make data entry easier.
3. Market Reputation: Client Reviews Matter
Market reputation can tell you all about the pros and cons of a credentialing system. A good company would have a solid reputation in the market. Although not all clients would have a satisfactory experience, it can still tell you about the company’s work ethic. To know about a company’s reputation, you can read reviews online or check the company’s rank on a rating website such as Trustpilot. You can also contact previous company clients by asking for references.
4. Pricing: Look for Transparency and Value
Costing matters! What matters more is how the company communicates the pricing and what value you will get from taking the service. Whether the cost is high or low, taking these factors into account would make it right for you. The best credentialing companies are transparent about their service charges, and there shouldn’t be any hidden fees. Secondly, you should have a good return on investment when choosing that company.
5. Compliance with Guidelines: Accreditations to Consider
A credentialing firm needs to follow the regulations set by the state or federal government. Before choosing a company, you should verify that it complies with industry standards. A good way to do that is to check for the company’s accreditations. Some trustworthy accreditors include NCQA, TJC, COA, and URAC.
6. Turnaround Time: Assess the Average Speed
Time is money! The credentialing process can take a lot of time due to several factors. The best healthcare credentialing company should have a good turnaround time. You can verify that by asking them about their average turnaround time. You can also find more information by checking reviews about the credentialing service.
7. Flexibility and Personalization: Custom Solutions Are Key
The medical industry is vast and diverse, and every healthcare provider has different needs. To fulfill these needs, a credentialing service must be flexible. Top credentialing companies dedicate an account manager to their clients and provide personalized solutions for their needs. They are flexible enough to make changes as healthcare providers’ needs evolve.
8. Training and Education: What Credentials Do They Have?
Education and training are essential for all healthcare providers. Credentialing is a challenging and tricky process, so regular workshops and training are critical to improving the understanding of your staff members. The best credentialing services provide educational material to their clients and conduct regular training programs to educate them, helping them clear up any misconceptions and better understand the credentialing process.
9. Customer Support: Communication is Crucial
Communication between the healthcare provider and the credentialing service provider is essential. Without good communication, the client’s needs will not be adequately conveyed to the service provider and will not be fulfilled. Good credentialing companies know this very well, so they provide fast and empathetic customer support, satisfying their customers.
Book a Call to Learn More About Our Provider Credentialing Services
Azulity specializes in healthcare master data management and provider credentialing services. Our comprehensive platform ensures consistent patient, provider, location, and claims data synchronization across all systems and departments. Key features include: healthcare MDM, provider MDM, reference data management, credentialing, and provider enrollment. We serve healthcare technology leaders – from CIOs and CDOs to VPs of data platforms and credentialing – helping them eliminate the costly problems of fragmented data systems. Book a call to learn more about our healthcare master data management services today!
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