Terms & Conditions

These Terms & Conditions (“Terms”) govern the use of services provided by Dr Credentialing (“Company,” “we,” “our,” or “us”). By engaging our services, executing a service agreement, submitting provider or organizational information, or accessing our website, you (“Client,” “Provider,” or “Organization”) agree to comply with and be bound by these Terms.

Dr. Credentialing provides administrative, compliance support, and consulting services to assist healthcare providers and organizations in obtaining payer participation, maintaining regulatory compliance, and achieving billing readiness. These Terms define the responsibilities, limitations, and obligations associated with the use of our services.

If you do not agree with these Terms, you should not use our services.

Scope of Services

Dr. Credentialing delivers administrative and compliance support services designed to help providers and healthcare organizations secure approvals, participate in payer networks, and maintain regulatory readiness. Our services support operational efficiency but do not replace legal, medical, or regulatory decision-making authority.

Services May Include

Credentialing & Qualification Verification

• Coordination of primary source verification for education, training, licensure, and certifications
  
  
• Preparation of credentialing files and compliance documentation
  
  
• Sanction and exclusion screening coordination through federal databases
  
  
• Verification responses to hospitals, payers, and credentialing verification organizations
  
  

Payer Enrollment & Network Participation

• Preparation and submission of Medicare and Medicaid enrollment applications
  
  
• Commercial payer enrollment coordination and tracking
  
  
• CAQH profile creation, maintenance, and attestation management
  
  
• Network participation documentation and follow-up with payers
  
  

Regulatory & Compliance Support

• Assistance gathering licensure and regulatory documentation
  
  
• Certification and accreditation readiness preparation
  
  
• Compliance documentation organization and audit preparation support
  
  

Financial & Billing Integration

• EDI enrollment coordination
  
  
• ERA and EFT setup facilitation
  
  
• Clearinghouse and billing readiness alignment
  
  

Ongoing Maintenance & Monitoring

• Recredentialing and Medicare revalidation tracking
  
  
• Provider demographic updates and change management
  
  
• Directory accuracy monitoring to support compliance requirements
  
  

All services are administrative and consultative in nature and are performed using information supplied by the Client.

No Guarantee of Approval, Participation, or Reimbursement

Dr. Credentialing utilizes industry best practices and compliance standards to improve application accuracy and approval success; however, approval decisions and participation eligibility are determined solely by external entities.

Approval outcomes depend on factors beyond our control.

Important Considerational Factors

• Payers determine participation eligibility based on network needs and panel status.
  
  
• Regulatory bodies evaluate certification eligibility through inspections and compliance reviews.
  
  
• Hospitals and facilities independently grant privileging approval.
  
  
• Credentialing decisions may be influenced by market saturation or geographic limitations.
  
  

We Do Not Guarantee

• Acceptance into payer networks
  
  
• Approval of credentialing or enrollment applications
  
  
• Specific approval timelines
  
  
• Reimbursement rates or contract terms
  
  
• Network participation when panels are closed
  
  

We provide process expertise and administrative support but cannot override payer or regulatory decisions.

Client Responsibilities & Required Cooperation

Successful credentialing and enrollment depend on timely cooperation and accurate information from the Client. Clients agree to actively participate in the process and fulfill the responsibilities outlined below.

Clients Are Responsible For Providing Accurate Information

• Complete legal names and demographic information
  
  
• Current licensure and certification details
  
  
• Work history, education, and training records
  
  
• Disclosure of past sanctions, disciplinary actions, or malpractice history
  
  
• Correct business ownership and tax documentation
  
  

Providing incomplete or inaccurate information may result in delays, denials, or compliance risks.

Clients Must Provide Documentation Promptly

• Submit requested documents within required timeframes
  
  
• Provide signatures, attestations, and authorizations when needed
  
  
• Respond to payer verification inquiries and follow-up requests
  
  
• Participate in site inspections, interviews, or audits if required
  
  

Failure to respond promptly may delay processing or result in application closure.

Clients Must Maintain Regulatory Compliance

• Maintain active and unrestricted professional licenses
  
  
• Comply with federal and state scope-of-practice requirements
  
  
• Ensure DEA and controlled substance registrations remain valid
  
  
• Maintain compliance with payer billing and documentation standards
  
  

Dr. Credentialing does not assume responsibility for lapses in licensure or regulatory compliance.

Clients Must Report Changes Immediately

Clients agree to notify Dr. Credentialing promptly regarding:

• Practice address or location changes
  
  
• Ownership or tax identification changes
  
  
• Banking or payment information updates
  
  
• Provider employment status changes
  
  
• Licensure, disciplinary actions, or sanctions
  
  

Failure to report updates may result in claim holds, reimbursement delays, or compliance violations.

Regulatory Compliance & Legal Responsibility

Healthcare providers and organizations are responsible for compliance with all applicable laws, regulations, and payer requirements governing healthcare delivery and billing practices.

Compliance Responsibilities Include

• State licensure and professional practice regulations
  
  
• Medicare and Medicaid enrollment requirements
  
  
• Medicaid managed care program compliance
  
  
• Federal fraud and abuse laws, including Anti-Kickback Statute and Stark Law
  
  
• Documentation, billing, and coding compliance requirements
  
  
• Accreditation and certification standards where applicable
  
  

Dr. Credentialing provides administrative support but does not assume liability for regulatory violations, billing practices, or clinical operations.

HIPAA Compliance & Confidentiality

Dr Credentialing implements administrative, technical, and physical safeguards to protect sensitive information consistent with HIPAA and applicable privacy laws. While credentialing services primarily involve provider and organizational data, limited Protected Health Information (PHI) may be encountered when required for payer enrollment or regulatory compliance.

Our Confidentiality Practices Include

• Restricting access to authorized personnel with role-based permissions
  
  
• Secure document storage and encrypted data transmission
  
  
• Confidentiality agreements for workforce members and contractors
  
  
• Secure disposal of sensitive records when no longer required
  
  

When services involve PHI on behalf of covered entities, Business Associate Agreements (BAAs) are executed where required.

Clients are responsible for transmitting sensitive information securely and avoiding unsecured communication channels.

Fees, Billing & Payment Terms

Service fees are outlined in written agreements, proposals, or invoices. Payment obligations must be fulfilled according to agreed billing schedules.

Payment Terms & Conditions

• Payment is due according to the invoice or agreement schedule.
  
  
• Services may be paused if accounts become overdue.
  
  
• Fees are non-refundable once work has commenced unless otherwise specified.
  
  
• Additional fees may apply for expedited requests or scope changes.
  
  
• Rework caused by inaccurate or incomplete client information may incur additional charges.
  
  

Timely payment ensures uninterrupted service delivery.

Service Timelines & Processing Delays

Credentialing and enrollment timelines vary significantly depending on payer processing speeds, regulatory reviews, and third-party verification responses.

Delays May Result From

• Missing or incomplete documentation
  
  
• Slow verification responses from institutions
  
  
• Payer backlogs or internal review cycles
  
  
• Panel closures or network capacity limits
  
  
• Regulatory inspections or certification surveys
  
  

Dr. Credentialing actively monitors progress but cannot control external processing times.

Limitation of Liability

To the fullest extent permitted by law, Dr. Credentialing shall not be liable for indirect, incidental, consequential, or special damages arising from service use or approval outcomes.

We Are Not Responsible For

• Payer denial of applications or network participation
  
  
• Lost revenue resulting from delayed approvals
  
  
• Regulatory decisions or certification outcomes
  
  
• Claim denials related to billing practices
  
  
• Network closures or payer policy changes
  
  

Our liability is limited to the amount paid for services rendered.

Termination of Services

Either party may terminate services in accordance with the service agreement terms.

Grounds for Termination May Include

• Failure to provide required documentation or cooperation
  
  
• Non-payment of agreed fees
  
  
• Misrepresentation of information
  
  
• Requests to perform unlawful or non-compliant actions
  
  

Upon termination, outstanding balances remain due and payable.

Intellectual Property & Use of Materials

All workflows, documentation formats, compliance tools, and proprietary processes developed by Dr. Credentialing remain the intellectual property of the Company.

Clients may use the provided documents for operational purposes but may not reproduce, distribute, or resell proprietary materials without written consent.

Policy Updates & Modifications

Dr Credentialing reserves the right to update these Terms to reflect regulatory changes, operational improvements, or legal requirements. Updated Terms become effective upon publication.

Continued use of services constitutes acceptance of revised Terms.

Governing Law

These Terms shall be governed by and interpreted in accordance with applicable federal laws and the laws of the state in which services are administered, without regard to conflict of law principles.