In today’s healthcare marketplace, the ability to accept potential patients’ insurance plans is essential for your practice’s success. Health insurance credentialing, also called provider insurance credentialing, is a process that medical insurance companies use so that you can apply for inclusion in their provider panels. If you wish to bill an insurance company as an in-network provider, you must undergo the credentialing process.

First, the insurance company you’re applying to will verify that you meet their internal requirements so that you can serve as an in-network provider on their panel. This could include your level of education, training and professional experience.

Once your practice or organization is credentialed with an insurance company, you can bill the payer directly. Also, many insurance companies offer providers other incentives, such as:

With Medvalue Healthcare, we help you get your applications completed twice as fast for Medicare, Medicaid, Aetna, Cigna, UnitedHealthcare, TRICARE and almost any other provider. Below are just a few functions we perform on your behalf throughout the credentialing process.

When considering which insurance companies you should be credentialed with, you must look at the major national plans, such as:

Those establishing a private practice are often confused about insurance credentialing and procedures for billing third-party networks for their services.

The first step in setting up your revenue cycle is applying for credentialing and obtaining participating provider contracts with your chosen insurance companies. While this can be complicated, MedValue Healthcare takes on this cumbersome process on your behalf. We provide you with guidance and industry know-how so that you can set up the revenue cycle for your new practice with ease.

Provider enrollment and insurance credentialing for government health programs such as Medicare, Medicaid and Tricare are a bit different. These programs have standardized forms that must be accurately filled out. They must then go to the appropriate intermediary who handles the administrative duties for the program in your jurisdiction.

MedValue understands these strict enrollment standards. We will take on this very detailed enrollment process so that your application has less risk of denial.

If you want to know how to get credentialed with insurance companies, please be aware that this process may take several months, and many insurance companies may not be accepting new providers on their panels. That’s why it pays to outsource this involved process. We provide professionals and organizations with extensive research and expertise to ensure we follow each payer’s guidelines, including:

We will help you submit a participating request to your chosen health plans using their specified credentialing application process. Once the health insurance company receives your credentialing application, employees perform a thorough verification process. Your file will then go to the company’s credentialing committee for approval. This process can take upwards of 90 days.

While this phase may feel drawn out, your dedicated MedValue Healthcare account manager will provide you with weekly or even daily real-time application updates.

The second phase of the credentialing process is called contracting. This is when your practice or organization’s application has been approved, and you’re extended a contract for participation. Many insurance networks separate the contracting phase from the credentialing step.

We help you through credentialing and also assist you with contracting negotiations before you sign your agreement, including:

Since 2005, MedValue Healthcare has worked with healthcare practices and organizations across the U.S., providing impeccable credentialing and enrollment services. If you need assistance completing the credentialing process with insurance companies in a timely manner, we ensure your credentialing and contracting goes as seamlessly as possible.

Countless organizations in every facet of the healthcare industry turn to MedValue because we customize our medical billing services to fit our clients’ needs. From consulting to taking action on your behalf, learn more about our services when you contact us online. Or, give us a call at 866-891-7607.

MedValue delivers end-to-end provider credentialing services—from initial credentialing and re-credentialing to continuous monitoring and upkeep. Our credentialing experts ensure full compliance with NCQA standards, CMS regulations, and specific payer requirements. Using advanced AI-powered document verification and OCR (Optical Character Recognition) technology, we accelerate primary source verifications for education, licenses, and malpractice history, dramatically reducing errors and turnaround times. Clients gain access to real-time credentialing dashboards, automated expiration alerts, and complete visibility into the enrollment workflow—enabling quicker onboarding and seamless payer participation.

At MedValue, our end-to-end Medical Billing and Revenue Cycle Management (RCM) services are built to drive maximum reimbursement, reduce denials, and elevate operational efficiency for healthcare providers. From charge capture and accurate medical coding (ICD-10, CPT, HCPCS) to payment posting, denial resolution, and AR follow-up—we handle it all. Our AI-enabled claim scrubbing tools automatically flag coding errors prior to submission, increasing clean claim rates. Predictive analytics further strengthen collections by identifying at-risk accounts for preemptive action. Comprehensive audit reports and compliance reviews provide full transparency and ensure adherence to regulatory standards, accelerating cash flow and supporting long-term revenue growth.

MedValue enhances the patient journey by managing key front-end administrative functions that improve access and engagement. Our services include real-time insurance eligibility checks, prior authorization processing, flexible appointment scheduling, and proactive communication through SMS, email, and voice channels. Intelligent AI chatbots handle routine queries, schedule triage, and support intake workflows, freeing human agents to focus on more complex cases. These capabilities boost patient satisfaction, reduce no-show rates, and improve workflow efficiency across both outpatient and inpatient care environments.

Accurate, timely documentation is essential for quality care and financial accuracy. MedValue equips healthcare providers with AI-powered medical transcription, speech recognition, and NLP tools that seamlessly integrate into leading EHR systems like Epic, Cerner, and Athenahealth. Our certified coders use AI-assisted platforms to assign correct ICD-10, CPT, and DRG codes, ensuring compliance with HIPAA and HITECH guidelines. The result: reduced administrative burden on physicians, enhanced coding precision, and documentation turnaround times cut by up to 40%.

Maintaining clean and current provider data is critical to operational efficiency and revenue continuity. MedValue delivers end-to-end provider data management—including CAQH updates, PECOS registration, payer directory submissions, and internal roster maintenance. Our AI-driven validation tools identify discrepancies across systems, allowing errors to be corrected before they impact credentialing or claims. Through regular audits and continuous updates, we help reduce recredentialing delays, eliminate out-of-network claim rejections, and ensure providers remain active within payer networks.

MedValue partners with CROs, pharmaceutical firms, and healthcare institutions to deliver robust clinical trial support. We manage EDC systems, maintain regulatory documentation, track patient logs, and oversee site management—all in full compliance with ICH-GCP standards. Our AI-enabled patient matching accelerates recruitment by pinpointing candidates who meet complex eligibility requirements. Additional services include remote monitoring, audit readiness, and regulatory packet coordination—helping studies progress faster and with greater accuracy.

Our secure, streamlined medical record retrieval services support the documentation needs of legal, insurance, and clinical stakeholders. MedValue works with healthcare facilities, insurers, and law firms to collect records under strict HIPAA compliance. Using AI-based indexing, we organize key documents—physician notes, diagnostic reports, treatment plans—for easy search and access. This automation reduces turnaround times and ensures clients receive organized, complete, and actionable documentation.

MedValue’s utilization review and case management services help healthcare organizations ensure clinical appropriateness and payer compliance. We manage intake, pre-certifications, concurrent reviews, and discharge planning with precision. Our AI algorithms flag potential issues like unnecessary procedures, extended stays, or documentation gaps. By supporting utilization review nurses and case managers with real-time data, we help cut costs, mitigate penalties, and ensure timely, appropriate care delivery.

As virtual care grows, MedValue offers customized telehealth support services that optimize the patient experience and operational flow. We manage remote patient intake, insurance verification, digital consent forms, and telehealth scheduling. Post-visit documentation and tech support are also provided to reduce friction and improve access. AI-driven chatbots streamline pre-visit engagement, reducing wait times and improving scheduling efficiency. Our solutions enable providers to deliver secure, smooth, and patient-centric virtual care.

Effective patient outreach and chronic condition management are central to value-based care. MedValue supports this through population health services—covering preventive care outreach, wellness programs, chronic disease monitoring, and care gap closure initiatives. Leveraging predictive analytics, we identify high-risk patients in need of timely intervention, helping prevent ER visits and avoidable admissions. Remote Patient Monitoring (RPM) data further enriches care planning, enabling providers to raise HEDIS scores, meet ACO benchmarks, and improve population health outcomes.