Initial Credential Verification

Every medical service provider is required to provide their credentials to the organization for which they are providing the service before they are eligible for full reimbursement. The process of giving this provider information to the organization is called credentialing.

Initial Credentialing involves primary source verification, or verification of a provider's information (licensure, education, board certification) by contacting the primary source that possesses that information. MedExperts credentials providers in accordance with the current standards set forth by NCQA, URAC and JCAHO. Credentials verification can be labor intensive and costly. You may currently do your own credentialing or, like many hospitals and health plans, have made the decision to outsource this function. Either way, it's becoming critical to have a valued partner who's ready to help meet your organization's specific needs.In addition can provide practices with credentialing and re-credentialing for third party payors.

MedExperts will provide completion of all applications and any follow up needed with the payors during the credentialing process: Final preparation and submittal of insurance enrollment packets to respective insurance plans; Communication of provider numbers and other pertinent information to provider's office staff; Complete any and all subsequent member demographics or practice changes with contracted payors; Complete any provider terminations and/or transitions; Facilitate payor site visits as required whether it's to acquire a particularly elusive piece of documentation, provide expertise in a complex situation, fill in during a crisis such as the unexpected loss of an employee, we can to help. With one phone call, we're on our way to providing the support you need - when you need it. You will receive primary source verifications within 15 to 30 working days from the date we receive an application from the practitioner. If some unforeseen delay does arise, you can count on being notified immediately of the application's status. If for any reason you are not completely satisfied, just let us know. If we can't remedy the situation, you don't pay.


MedExperts performs primary source verification of the following elements required by JCAHO and NCQA

    * Graduation from Medical School

    * State Medical License(s)

    * Internship

    * Residency

    * Fellowship

    * Board Certification

    * Professional Liability Claims History

    * Hospital Privileges

    * Professional References

    * Medicare/Medicaid Status with the Department of Health and Human Services

    * NPDB Query

    * AMA Profile

Recredentialing Verification

MedExperts recredentialing verification service provides an efficient, high-quality solution to fulfill the recurring recredentialing requirements of NCQA, JCAHO and URAC. Re-credentialing of providers typically takes place every two years following initial credentialing and entails verification of information that could have possibly changed within the previous two years.

MedExperts manages each provider's recredentialing cycle and automatically delivers the requisite credentialing file in advance of the credentialing committee date, without further client request.