What Is Credentialing and Why Does It Matter for New Providers?

If you’re a new provider, whether a therapist, doctor, nurse practitioner, physician assistant, doula, or other wellness practitioner, you’ve likely heard about credentialing. But what is it really, and why is it essential to your business growth?

At HMV Solutions, we help providers navigate insurance credentialing and provider credentialing so they can grow profitable, organized practices. Let’s break down what credentialing is, why it matters, and how to start the process with confidence.

What is Credentialing?

Credentialing is the process of verifying a healthcare provider’s education, licensure, training, and qualifications to ensure they meet the standards required by insurance companies, healthcare networks, and regulatory bodies.

Without it, you can’t accept commercial insurance, Medicaid or Medicare, which limits the number of clients who can access your services affordably.

Why Credentialing Matters for New Providers

1. Grow Your Client Base

Credentialing allows you to become an in-network provider, giving clients the option to use their insurance benefits for your services.

2. Establish Professional Credibility

It signals that you’ve met industry standards and can be trusted to deliver quality care.

3. Work With More Employers

Hospitals, group practices, and community agencies require providers to be credentialed to work with them.

4. Ensure Compliance and Protect Your Practice

Credentialing aligns you with legal and ethical standards in healthcare, safeguarding your reputation and practice.

What is CAQH and Why Is It Important?

The Council for Affordable Quality Healthcare (CAQH) operates CAQH Provider Data Portal, formally known as CAQH ProView, the centralized system providers use to maintain and share credentialing information with insurers.

Your CAQH ID number connects insurance companies to your verified qualifications. Maintaining an up to date CAQH profile is essential for ongoing credentialing and re-attestation.

At HMV Solutions, we offer CAQH setup and maintenance services to ensure your profile is accurate and current.

If you are interested in getting support today, click HERE and let’s chat! I look forward to providing you and your practice support. 

The Credentialing Process in a Nutshell

1. Apply to Insurance Panels like Aetna, Cigna, and Medicaid.

   
   

2. Complete Your CAQH Profile with your education, licenses, malpractice insurance, and work history.

   
   

3. Credentialing Verification is completed by insurers and can take 60-120 days.

   
   

4. Approval or Additional Requests will follow from each insurance company.

Common Challenges for New Providers

• Incomplete documentation

• Misunderstanding CAQH requirements

• Lengthy delays due to errors or missed follow-ups

Credentialing help is essential to avoid these pitfalls and keep your practice moving forward.

How HMV Solutions Supports Your Credentialing

We specialize in helping Black and brown women medical providers, therapists, doulas, and wellness professionals streamline credentialing and practice management.

Our Credentialing Services:

• CAQH Application Completion & Profile Maintenance

• Insurance Enrollment Applications

• Credentialing Tracker Template (Digital resource available for purchase HERE)

• NPI Registration Assistance

Conclusion

Credentialing is more than paperwork, it’s a business strategy that positions you and your team for growth, credibility, and income potential.

If you’re a new provider ready to get credentialed and panelled with insurance companies, let HMV Solutions be your guide. Click the link HERE and let’s get started!