> ## Documentation Index
> Fetch the complete documentation index at: https://docs.athelas.com/llms.txt
> Use this file to discover all available pages before exploring further.
# 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.
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.*
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.*
If an appointment is being set up for provider `Abhi Provider` and the patient insurance is `Mercy Care`:
1. If the appointment is being scheduled at `Main Office`, the facility-level credentialing entry would cause the appointment to be blocked on creation.
2. 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. |
You will have 3 options: **Licensed**, **Temporary**, and **Not licensed**. In this example, we click on **Temporary**.
If the licensing status is temporary, you must add an expiration date.
## Provider credentials
This would be under the Utilities section.
We also show the individual NPIs. Select one provider.
Select one of the insurance companies. You can search by the insurance company's name as well.
You can select a credentialing type per entry. Supported entries include: Unknown, Group, Individual, Pending, and None.
For example, if the provider is already credentialed:
**Example video:**
You can select multiple rows across different providers, insurance companies, and credentialing groups.
You have the ability to change the `Credentialing type`, `Credentialed`, and `Cosigner Required` values.
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.
**Example video:**
You can see we are showing 1–10 rows out of 18 total.
You can see the message **Selected 10 on this page**. This will only make edits to the 10 selected rows.
**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
Go to [https://insights.athelas.com/provider-credentialing](https://insights.athelas.com/provider-credentialing).
* Enter a group name (e.g., "Optum Group", "Medicaid Plans").
* Add an optional description.
* Select insurance companies to include in the group.
### Editing Credentialing Groups
Modify the details as needed (name, description, insurance companies).
### Adding Credentials Using Groups
* **Individual**: Select a specific insurance company, **OR**
* **Group**: Select one or more credentialing groups.
Set the type, status, and cosigner requirements.
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.
Click on the credentialing group → down arrow icon → `Edit Credentialing group`.
On the bottom of the drawer, you can see `Delete credentialing group`.
A confirmation modal appears. On click of `Delete Group`, the credentialing group would be permanently deleted.
**Example video:**
### Using credentialing group as filters
Click the `+ Filter` button above the table. This will show various filters. Select `Credentialing Group`.
On click, the table would load the filtered rows.
**Example video:**
### Using credentialing groups to add credentials
Based on the credentialing type, you would get the options to modify `Credentialed` and `Cosigner required`.
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.
> 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.*
1. If the appointment is being scheduled at `Main Office`, the facility-level credentialing entry would cause the appointment to be blocked on creation.
2. 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.
* **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.
> 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.*