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What is provider credentialing?

Provider credentialing is a regulated process of assessing the qualifications of specific types of providers. This important safety check requires providers such as doctors, dentists, and other allied healthcare professionals to show they have the proper education, training and licenses to care for patients.

Is HMSA a health care provider?

HMSA is the most experienced health plan in the state, covering more than half of Hawaiis population. As a recognized leader, we embrace our responsibility to strengthen the health and well-being of our community.

What does it mean to be credentialed by insurance companies?

Credentialing is a process that the insurance companies use to verify your education, training, and professional experience and to ensure that you meet their internal requirements for serving as an in-network provider on their panel.

What is the HMSA authorization to release documents and information and dispute resolution agreement?

The HMSA Authorization to Release Documents and Information and Dispute Resolution Agreement is required by law and confirms that youre aware that HMSA performs peer, quality assurance, accreditation, and compliance reviews with its participating providers.

What is the difference between credentialing and provider enrollment?

In summary: Both are essential for a providers ability to practice medicine and receive reimbursement for services. The focus of credentialing is on clinical qualifications and quality assurance, while enrollment emphasizes administrative and financial aspects of the providers relationship with payers.

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