Starting A Private Practice With Credentialing

When you move from a large healthcare provider to open a private practice, there are a myriad of details to consider to make sure you’re free to see as many patients as possible by credentialing with insurance companies. The major part of this process is credentialing, where you prove your professional experience and specialty to act as an in-network provider to access patient lives in your area. Here’s what you should know about the credentialing process and why a partner like PayrHealth can be hugely beneficial.

What is Credentialing?

The credentialing process involves filing internal paperwork with as many insurance companies as you can to verify your education and training and to become listed on their publicly available directories of providers. Once you’re credentialed, you can then move into the contracting phase where you and your payors establish reimbursement rates for your services.

Credentialing is the necessary first step to attracting patients who want to see in-network providers for the cost benefits of having the insurer partially or completely pay for their care.

Identifying Ideal Payors in Your Area

A major hurdle for some new practices is determining which insurance companies serve the most people or provide the best value for its patients in your county and the surrounding areas. Some office managers have this information based on experience, but when it comes to important decisions that spur contracts that last years, it helps to have real-time data on your hands. That’s where PayrHealth can help. With the relationships we’ve forged with insurance companies that serve patients nationwide, we can provide a high-value strategy to ensure you credential with the right companies for your specific area and specialty.

Your options for credentialing are numerous, from government plans like Medicare to major private insurance firms such as BCBS. Knowing who in your area serves the most patients is key to your revenue cycle.

Requirements for Credentialing and Contracting

Once you’ve established your practice and obtained a business entity, there are a few accounts you need to settle before reaching out to insurance companies. First, make sure you have a professional liability insurance policy to cover your practice. You also need to make sure you’re fully licensed in your state, including prescriptive authority. Finally, create a profile for CAQH and set reminders to keep it updated in the years to come.

The Credentialing Process

The actual work of applying for credentials with an insurance company is time-consuming and can be stalled due to mistakes in filing or following up with networks. This is another aspect of the credentialing process that PayrHealth can completely take off your hands, so you can focus on the more important aspects of running a practice. Plus, once your credentials are accepted, we can help establish competitive reimbursement contracts with revenue cycle management services and database of health plan partners through negotiations for your contracts.

Create a Strong Revenue Cycle with PayrHealth

Opening your own practice is an ordeal, but one we’re able to help you through. Our revenue cycle management services give you a strong, competitive foundation on which to build a thriving practice that serves your community and can scale effectively. Learn more about what makes PayrHealth your unique partner through the credentialing process and beyond by calling us today.

Learn more about PayrHealth today


Our mission starts with an excellent experience and a target of lasting success for your health care organization. We see a future where providers and payors partner in making informed decisions for a strengthened healthcare system.

PayrHealth can take support your organization and its revenue goals. Connect with our team of experienced healthcare professionals to get the conversation started.