Skip to main content

​
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

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

​
Selecting credentialing type values

  • You can select either of the 3 values:
Is credentialed?Cosigner required?Allowed?
✅❌✅
❌✅✅
❌❌✅
✅✅❌
  • Group to selection of values:
Credentialing typeCan select Is Credentialed?Can select Cosigner required
Group✅❌
Individual✅❌
Unknown✅✅
Pending✅✅
None✅✅

​
Provider credentials

​
Adding a provider credential

Steps:
  • Click on + Add Credentialing button once navigating to ‘Provider Credentialing’ tab within Utilities
  • Select the provider name from the list of providers from the site.
  • Select the insurance company from the list of insurance companies.
  • 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 entry would be created.

​
Bulk edit provider credentials

Steps:
  • In the table, you can select multiple rows by clicking on the empty checkboxes to the left of the row.
  • You can select multiple rows across different providers, insurance companies, and credentialing groups.
  • You have the ability to change the:
  • Credentialing type
  • Credentialed
  • Cosigner Required
  • You can either keep the existing values for these rows, or apply the same settings to all rows.
  • Click on Submit to reflect your changes.
  • Example video:

​
Select all results in a filter for bulk editing

When a filter is applied, a prompt to select all the results for bulk editing shows up.

​
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 Provider Credentialing page
  • 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
  • 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 (type, status, 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 new “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. Steps:
  • Click on the credentialing group, then the down arrow icon, then Edit Credentialing group
  • Select the group to be edited.
  • On the bottom of the drawer, you can see the Delete credentialing group.
  • A confirmation modal appears. On click of Delete Group, the credentialing group would be Permanently deleted!

​
Using credentialing group as filters

Steps:
  • Click the + Filter button above the table. This will show various filters. Select Credentialing Group
  • You can search for various groups.
  • Click on each row to select/deselect the credentialing group.
  • On click, the table would load the filtered rows.

​
Using credentialing groups to add credentials

Steps:
  • Click on + 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.