Q & A on Credentialing a Medical Provider – Why is this Necessary?

Q. What is credentialing?

A. It is a process by which insurance carriers and hospitals verify the credentials of the medical provider. This includes verification of licenses, verification of malpractice insurance, verification of college degrees and background checks to disclose any felonies or criminal activity.

Q. Why is credentialing important? Who is it important to?

A. It is important to the provider to maintain his credibility with the insurance carriers and to hopefully receive a contract to participate in an insurance companies various programs. This is critical to a medical provider due to the fact that most of us want to see a doctor in our network as it creates a savings for us with our medical expenses. Most out of network benefits require us, the patient, to meet a deductible before any payments to the provider of services are made.

Q. How does credentialing help the medical provider?

A. Once a medical provider is credentialed and accepted into an insurance plan, their information is then posted in the provider directory. If a patient is looking for a medical provider in their network, they usually search by zip code. If a medical provider is not listed in that directory, the medical provider has missed the opportunity to get a new patient. Therefore, credentialing in a sense is a marketing tool as well.

Q. How does a medical provider go about the process of credentialing?

A. Credentialing is an extremely time consuming process and requires an individuals’ undivided attention. Current documents must be attached to a standard application which should be type written for legibility. Documents include licenses, diplomas, resumes, and declaration pages of the current malpractice. A cover letter should accompany the application and documents, introducing the provider to the carrier or hospital. Most providers use an outside service for this process.

Q. How long does it take to be credentialed?

A. Most carriers take from 90-180 days to complete their credentialing process. Once the provider is credentialed, the applications goes before a committee for final acceptance into an insurance plan.

Q. How will the provider know if they are accepted into a plan?

A. Most carriers inform the provider via letter along with a welcome packet of some type. Another method is to track your application which requires someone to contact the carrier every couple of weeks to check the status of the application.

All in all, credentialing is a very important part of the medical providers’ business.

Find Doctors That Take Your Insurance

Did you know that you can use your insurance company to find doctors? Instead of looking through a phone book or just attempting to contact someone, you can start with the physicians in your area that take your insurance. In the long run, this is going to save you a lot of money and ensure that you are using your medical benefits to the best of your ability.


Most insurance companies have a site online that can help you find doctors within your network. After finding the site, you usually will need to create a username and password. In order to tso this, you will need to have your contact information, including your social security number as well as your medical insurance card. Usually contact is made through email, so you want to include that as well.

Once you have an account, look for a page that gives you the chance to find doctors that are covered. You can search by zip code or type of physician (general practitioner or specialist). If you already have a name in mind, or even part of a name, you can usually search by that as well. This is one of the most convenient ways to look for a physician because you can do it whenever you want, at your own pace and there is no rush to make a decision.

Over the Phone

You can call the customer service line to speak with a representative of your medical insurance to go over some of your options with you. While this is also easy, it can end up being time consuming. Instead of seeing a list all at one time, you are hearing one at a time and writing down the information as it is given. If you lose the list you will need to call again, and if one physician doesn’t work out, you will need to call again to start the process over again.

Insurance Enrollment Packet

When you sign up for insurance, you get an enrollment packet that details your coverage, its limits and all of the benefits that you are entitled to. If you look through all of the information, you will use the paperwork as a guide to find doctors; usually they are listed in alphabetical order.

While this seems convenient, it can be tough to find out who is accepting new patients. Because that information changes all the time, you may be looking at a list that isn’t up to date and doesn’t contain completely accurate information. You will still need to call any of the offices that you are interested and and see if they are accepting anyone new.

Remember, you can always talk to friends, family members and co-workers to find doctors in your local area. Just double check and make sure that they accept your insurance before making an appointment. While you want to see a physician that you think will work well with you and your family, you also want to have all appointments and treatments covered by your medical insurance.

Six Things to Look For When Choosing a Chiropractor

When I drive down the street these days, it seems as if there is a chiropractor on every corner. The difficult part is figuring out which chiropractor to go to. You might be reading this and thinking “I thought all chiropractors just crack and pop backs to relieve back pain.” That is the absolute furthest thing from the truth.

Yes, there are those chiropractors that perform what Dr. Tony Palermo describes as the “FTHSAMI” (Find The High Spot And Mash It) technique. And there are chiropractors that don’t perform adjustments, but offer nutritional counseling instead.

Chiropractors differ in their techniques as much as medical doctors. In medicine, you have orthopedists, podiatrists, gastroenterologists, proctologists, OB/GYNs, and the list goes on and on.

It’s the same with chiropractic. You can see someone who does Blair Upper Cervical, NUCCA, Gonstead, diversified, applied kinesiology, Thompson, CBP, neuro-emotional technique, Logan basic, BEST, and, again, the list can go on and on.

What to Look For

Finding a good chiropractor is not hard, it might just take a little due diligence on your part. I’ve assembled a criteria that I think helps in finding a good chiropractor that you will feel comfortable with.

1.) Great Phone Etiquette- Calling around different chiropractic offices is where you’ll probably start. Make sure that when you call, the person answering on the other end is outgoing and friendly.

Also, make sure they can explain to you what they do. Getting someone like 65-year-old Thelma, who has a deeper voice than Barry White from smoking two packs of cigarettes a day since she was sixteen, is probably the first and only indication you need to pass on that office.

2.) Great Office Staff- The front desk CA (Chiropractic Assistant) has to be friendly and helpful. No one likes filling out paperwork and new patient forms or packets. If the front desk CA can get you through the first day routine without you acquiring a headache is key.

Payment arrangements and scheduling also get taken care of by this person. Make sure they get you scheduled for at least two weeks worth of appointments right off the bat. This way, you’re not wasting time trying to schedule your next appointment after every visit.

3.) Great Aesthetics– This is where you walk in to a chiropractic office and your first thought is “Wow!” The environment is peaceful, clean, organized, and flows smoothly.

Walking in somewhere where the doctor has a collection of old, worn furniture from a junkyard, the paint is peeling, and the front desk looks like someone took a leaf blower to a stack of papers is your sign to get out of there fast! This is something you’ll notice right as you walk in, or at least you should.

4.) Doctor is an Effective Communicator- Sure, the chiropractor may be the most skilled at his or her technique. But if they don’t explain to you in a way that you get it and understand the importance of your care, who cares how good they are at their technique?

An effective chiropractor will be able to explain your situation and how he or she can correct it. If they don’t tell you anything or act like you wouldn’t understand, there’s your sign. I’ve seen chiropractors who think they know everything and the patient knows nothing. Not a fun time, I can assure you.

5.) Doctor Does Pre- and Post-Analysis– If you’re going to see your traditional diversified “FTHSAMI” chiropractor, you might as well go to a physical therapist or an osteopath. The point is not to get your bones moved, it’s to detect and correct vertebral subluxations. Ways that a doctor can check you are x-rays, leg checks, thermography scans, or muscle tests.

You want a chiropractor that can find a subluxation, if you have one. If you do, you want that chiropractor to correct it. Lastly, you want that chiropractor to make sure they removed the subluxation. Vertebral subluxations are so life-altering, especially in the upper cervical spine, that you better make sure your chiropractor can properly correct it.

6.) Know What Technique You Prefer- Knowing what technique a doctor utilizes in correcting a subluxation is important. Not everybody likes the same chiropractic technique. The Blair and NUCCA Upper Cervical techniques utilize a hand adjustment. Some people might prefer an Orthospinology or Atlas Orthogonal adjustment, which utilize a tool instead. You might like applied kinesiology, which takes a whole body approach and does its analysis by muscle testing. It’s really up to you.

You have to know what you’re looking for. Do some research online. It’s not hard to find out about the different techniques. Once you do, find out which doctors use that particular technique in your area. Here is a great website to do just that. If your chiropractor has all six of these components as part of their practice, chances are that you’re in good shape. If even one of these is missing, go find a chiropractic office that has all these components. They are out there. You just have to search.