Provider Credentials

Overview

The Self-Serve Credentialing Matrix is a centralized tool designed to simplify and standardize how providers and insurance companies manage credentialing requirements. It provides an at-a-glance reference for the credentialing status of each provider–payer relationship, ensuring clarity, compliance, and faster decision-making. Credentialing is a critical process that validates whether providers meet the requirements of insurance companies to deliver care under their plans. Traditionally, this information is fragmented, requiring manual lookups and repeated back-and-forth. The self-serve credentialing matrix eliminates that friction by giving all stakeholders immediate visibility into credentialing statuses.

How would it help?

Efficiency – Cuts down on time spent searching for or verifying credentialing requirements.
Transparency – Provides providers and payers with a shared source of truth.
Scalability – Supports onboarding, cross-coverage, and expanding provider networks with minimal administrative overhead.

Key concepts

Term	Meaning
Provider	A healthcare professional or organization (e.g., physician, nurse practitioner, clinic) delivering care to patients.
Insurance company	A payer organization that contracts with providers to cover healthcare services for its members.
Provider credentials	The qualifications, licenses, certifications, and verifications required for a provider to be approved by an insurance company.
Credentialing group	A set of providers managed together for credentialing purposes, often by specialty, practice, or organizational affiliation.
Credentialed	Indicates whether a provider is fully approved and recognized by the insurance company to deliver covered services.
Cosigner required	Shows whether the provider can deliver services only under supervision, requiring a credentialed provider’s cosignature (e.g., trainees, newly licensed practitioners).
Credentialing type	Type of credentialing. Includes `GROUP`, `INDIVIDUAL`, `UNKNOWN`, `PENDING`, `NONE`.

Selecting credentialing type values

You can select any of the 3 allowed combinations (the 4th, shown below, is not allowed):

Is credentialed?	Cosigner required?	Allowed?
✅	❌	✅
❌	✅	✅
❌	❌	✅
✅	✅	❌

The credentialing type determines which values you can set:

Credentialing type	Can select `Is Credentialed?`	Can select `Cosigner required`
Group	✅	❌
Individual	✅	❌
Unknown	✅	✅
Pending	✅	✅
None	✅	✅

Facility Specificity

If facilities are not specified for the Insurance Company or Credentialing Group, then the credentials will be applied site-wide. You are allowed to have different types of credential for different facilities, and it will impact the overall outcomes for Appointment Scheduling and Chart Note Signing.

Choosing Facilities

For Insurance Mercy Care, we set MAIN OFFICE to a Pending state, and for the rest of the facilities this insurance was credentialed.📹 Video demonstration — a screen recording for this scenario is available in the source guide and needs to be uploaded (Loom/YouTube) and embedded here.

Creating Appointments for different facilities (with blocks)

You can still bypass a block and create the appointment by checking Override Credentialing Matrix.📹 Video demonstration — a screen recording for this scenario is available in the source guide and needs to be uploaded (Loom/YouTube) and embedded here.

Example: a provider with entries across facilities

If an appointment is being set up for provider Abhi Provider and the patient insurance is Mercy Care:

Credentialing matrix entries for a provider across multiple facilities

If the appointment is being scheduled at Main Office, the facility-level credentialing entry would cause the appointment to be blocked on creation.
If the appointment is being scheduled at a facility not named Main Office or Gary J Smith, then the appointment would be created since the provider is credentialed under the group.

Provider Licensing

Provider Licensing holds the licensing status of a provider. The three different types of provider licensing are:

Licensing type	Details
Licensed	Holds a valid NPI.
Temporary	Typically meant for students who would not have an NPI number. For a temporary number, you would need to enter an expiration date (not more than 1 year).
Not Licensed	Does not have a temporary or a permanent number. Cannot schedule appointments at all.

Licensing setup

Go to EHR > Preferences

Click on the Provider tab

Click on the pencil icon to edit a provider's information

Expand the licensing status option

You will have 3 options: Licensed, Temporary, and Not licensed. In this example, we click on Temporary.

Fill the temporary license expiration date

If the licensing status is temporary, you must add an expiration date.

Expiration date cannot be more than 1 year from now

Click on Save to reflect these changes

Provider credentials

Adding a provider credential

Navigate to Provider Credentialing

This would be under the Utilities section.

Provider Credentialing in the Utilities section

Click on Add Credentialing

Search for provider names

We also show the individual NPIs. Select one provider.

Search for insurance companies

Select one of the insurance companies. You can search by the insurance company’s name as well.

Select credentialing type

You can select a credentialing type per entry. Supported entries include: Unknown, Group, Individual, Pending, and None.

Check the relevant values for the credentialing type selected

For example, if the provider is already credentialed:

Set the credentialed and cosigner values

Click on Confirm to save your changes

You can see the success message

Example video:

Bulk edit provider credentials

You can select multiple rows across different providers, insurance companies, and credentialing groups.

Select multiple rows on the table

Use the edit section on the right of the table

You have the ability to change the Credentialing type, Credentialed, and Cosigner Required values.

Change values for the selected rows

You can either keep the existing values for these rows, or apply the same selected settings to all rows. In this case, we are setting all selected rows to Yes for Cosigner required.

Click on Update to save your changes

You can see the success message

Example video:

Select all results in a filter for bulk editing

Select the adequate filters

Review the result count

You can see we are showing 1–10 rows out of 18 total.

Check the box on the table header

Select all rows on the page

You can see the message Selected 10 on this page. This will only make edits to the 10 selected rows.

Click on Select all 18 results to select every row in the filter

All 18 rows are now selected

Make the edits accordingly

Click on Update to reflect your changes

Example video:

Credentialing Group

Credentialing group allows you to bundle multiple insurance companies under one group, so when you get credentialed for a group, you can apply the same configuration.

Important Notes:

An insurance company can be part of multiple credentialing groups.
Groups are mutually exclusive with individual insurance selection in the Add Credential modal.
You can select multiple groups when adding credentials to credential a provider with all insurances across those groups.

Creating Credentialing Groups

Navigate to the Provider Credentialing page

Go to https://insights.athelas.com/provider-credentialing.

Click the + Credential Group split button in the top right

Fill out the group details

Enter a group name (e.g., “Optum Group”, “Medicaid Plans”).
Add an optional description.
Select insurance companies to include in the group.

Click Save Group to create the group

Editing Credentialing Groups

Click the dropdown arrow on the Credential Group button, then select Edit Credential Group

Choose the group you want to edit from the dropdown

Modify the details as needed (name, description, insurance companies).

Click Save Group to update, or Delete Group to remove it

Adding Credentials Using Groups

Click Add Credentialing to open the credential modal

Select a provider

Choose your credentialing approach

Individual: Select a specific insurance company, OR
Group: Select one or more credentialing groups.

Set credential details

Set the type, status, and cosigner requirements.

Click Confirm

The system will automatically create individual credentials for each insurance in the selected groups.

Viewing Group Information

Table column: The “Credentialed Group” column shows which groups each provider belongs to.
Filtering: Use the “Credentialing Group” filter to view only providers who qualify for specific groups.

Group qualification: Providers only appear in a group if they have credentials for ALL insurance companies in that group.

Deleting a credentialing group

You can also delete a credentialing group.

Open the credentialing group editor

Click on the credentialing group → down arrow icon → Edit Credentialing group.

Select the group to be edited

Find the delete option

On the bottom of the drawer, you can see Delete credentialing group.

Confirm the deletion

A confirmation modal appears. On click of Delete Group, the credentialing group would be permanently deleted.

Example video:

Using credentialing group as filters

Open the filters

Click the + Filter button above the table. This will show various filters. Select Credentialing Group.

Search for various groups

Click on each row to select/deselect the credentialing group

Load the filtered rows

On click, the table would load the filtered rows.

Example video:

Using credentialing groups to add credentials

Click on the + Add Credentialing button

Select the provider name from the list of providers from the site

Select the credentialing group from the existing list of credentialing groups

Select the credentialing type

Based on the credentialing type, you would get the options to modify Credentialed and Cosigner required.

Click on Submit

The provider credentialing entries for provider + insurance companies under the credentialing group would be created.

Example video:

Scheduling and Signing logic blocks

Both the provider licensing and credentialing setup should be completed for a provider in order to have access.

Each scenario below is demonstrated by a screen recording in the source guide. Those recordings need to be uploaded (Loom/YouTube) and embedded under their respective headings.

Enforce Direct Access

Here is the setup to allow/disallow direct access patients. This is on EHR > Preferences > Providers.

Allowed to See Direct Access Patients setting

Schedule a Direct Access visit with a provider who is not credentialed for Direct Access cases — the system should flag or restrict the action.

📹 Video demonstration to be embedded.

Block Scheduling for Non-Credentialed, Non-Co-Signing Provider

Try scheduling a visit with a provider who lacks payer credentialing and co-signing privileges — expect the system to block or warn accordingly.

📹 Video demonstration to be embedded.

Enforce Co-Sign Requirements for Non-Credentialed Providers

A) Attempt to schedule an appointment with a provider marked as “Co-sign Required” for the selected payer.

Expected behavior: the system should flag the need for a credentialed supervising provider before proceeding.

B) Assign a supervising provider who is credentialed with the payer and complete scheduling successfully.

Expected behavior: the system validates the supervising provider and allows the appointment to be scheduled without error.

📹 Video demonstration to be embedded.

Attempt to Schedule with Expired License

A provider previously held a temporary license, but it has since expired.

Expected behavior: the system should prevent appointment scheduling and surface a clear message indicating the provider’s license is no longer valid.

📹 Video demonstration to be embedded.

When submitting a note

Scenario 1: A provider whose license is expired is trying to submit a chart note — they cannot submit it. 📹 Video demonstration to be embedded.

Getting Started with Air

View your Calendar

Review Patient Details

Communicate with Patients

Portal and Online Scheduling

Check-in a Patient

Fill a Chart Note

Take in a Patient

Manage your Tasks

Manage your Practice

Analyze your Reports

ONC Certification

ONC Feature Guides

FHIR API

Provider Credentials

Overview

How would it help?

Key concepts

Selecting credentialing type values

Facility Specificity

Provider Licensing

Provider credentials