{"id":28326,"date":"2025-07-01T17:47:49","date_gmt":"2025-07-01T17:47:49","guid":{"rendered":"https:\/\/progyny.com\/?p=28326"},"modified":"2025-07-16T17:59:11","modified_gmt":"2025-07-16T17:59:11","slug":"why-credentialing-is-the-backbone-of-quality-healthcare","status":"publish","type":"post","link":"https:\/\/progyny.com\/blog\/fertility-in-the-workplace\/why-credentialing-is-the-backbone-of-quality-healthcare\/","title":{"rendered":"Why Credentialing is the Backbone of Quality Healthcare"},"content":{"rendered":"\n

By Sam Correll, SVP of Network Management at Progyny<\/em><\/p>\n\n\n\n

When dealing with some of life\u2019s most pivotal health moments \u2013 from conception and pregnancy, to postpartum and menopause \u2013 patients deserve providers who have been thoroughly vetted. Yet, with many vendors saying they have \u201cnetworks,\u201d understanding how they vet – and perhaps, most importantly, if they credential – their network is key.<\/strong><\/p>\n\n\n\n

With 25 years of experience focused on provider relationships and networks across medical and pharmacy communities, I\u2019ve seen firsthand how rigorous credentialing processes ensure quality care. Credentialing is much more than a one-time approval; it\u2019s an ongoing process that holds providers accountable for the highest level of care.<\/p>\n\n\n\n

Below I\u2019ve broken down some of what credentialing entails and why provider credentialing and active management is a cornerstone of our business model at Progyny.<\/p>\n\n\n\n

Credentialing 101 <\/h2>\n\n\n\n

Credentialing is essential in healthcare \u2013 it\u2019s what ensures that providers and health plans meet the highest standards. More than a one-time requirement, credentialing is an ongoing process that assesses a variety of important factors (licensing, certifications, sanctions) for every provider in a network. For patients and employers, this means confidence in receiving top-tier care.<\/p>\n\n\n\n

One of the most respected accreditations in healthcare is NCQA\u2019s<\/a> (National Committee for Quality Assurance) three-year accreditation for Credentialing. This certification isn\u2019t just a stamp of approval, it reflects a commitment to quality improvement, patient safety, network adequacy, and member experience. Health plans often require their partners to achieve this accreditation so they can delegate credentialing activities \u2013 reducing the health plan\u2019s administrative burden and ensuring compliance without redundant oversight. This streamlines provider network management while maintaining the highest levels of patient safety. Progyny has earned this prestigious recognition by exceeding national standards across the assessed categories.<\/p>\n\n\n\n

We pair our NCQA accreditation with a URAC<\/a> (Utilization Review Accreditation Commission) accreditation for operational excellence and HiTrust certification<\/a> for data security, reinforcing our dedication to value-based care \u2013 where success is measured not just by procedures performed but by real patient outcomes.<\/p>\n\n\n\n

Beyond Credentialing<\/h2>\n\n\n\n

Progyny\u2019s network supplements NCQA credentialing standards with additional inclusion standards and monitoring requirements, so employers and patients using our benefit can rest assured they are receiving the best care from the best specialists. Our Credentialing Committee \u2013 composed of Board-Certified Ob\/Gyns, Reproductive Endocrinologists (REI), Reproductive Urologists (RUs), and certified menopause specialists, with decades of experience \u2013 ensures that only the most qualified providers join our network, setting the bar for excellence in reproductive care.<\/p>\n\n\n\n

Progyny also has rigorous inclusion standards for our providers. We look for those who have accomplished specialized fellowship trainings (i.e., REI, RU) or certifications (i.e., menopause) to ensure our providers have deep expertise that will result in the best patient care. After a provider joins our network, ongoing active reporting unique to Progyny begins. Our providers submit outcomes to us on every treatment so that Progyny can continue to ensure our network meets the highest standards.<\/p>\n\n\n\n

Additionally, through our pharmacy program, we\u2019re able to partner with providers to ensure members get the medication they need for treatment and our pharmacies have dispensing protocols to avoid excess waste and cost. Annually, providers must attest that their embryology lab, andrology lab, endocrinology lab, and facility certifications and licensing meet requirements. All of this contributes to safer, more effective care.<\/p>\n\n\n\n

Why is this important?<\/h2>\n\n\n\n

Women\u2019s healthcare is often fragmented, with patients navigating multiple providers throughout their journey. In such a complex landscape, a higher standard of credentialing ensures better coordination, consistency, and outcomes.<\/p>\n\n\n\n

What truly sets a network apart, however, is how they maintain these standards. For example, from the first day a provider joins Progyny\u2019s network, we hold them accountable to these rigorous expectations. Regular practice reviews, continuous monitoring of outcomes, and ensuring appropriate utilization of resources like drug access programs are just a few ways we help our providers maintain excellence. It\u2019s not just about maintaining the status quo, it\u2019s about raising the bar so that every member on their health journey receives the care they deserve.<\/p>\n\n\n\n

\n

Credentialing is much more than a one-time approval; it\u2019s an ongoing process that holds providers accountable for the highest level of care.<\/p>\n<\/blockquote>\n\n\n\n

The last thing I\u2019ll say is that employers should feel empowered to ask their health plan or benefits provider: ‘What credentialing accreditation do you have and require?’ and ‘How do you manage these providers and maintain standards? Do you collect 100% of provider outcomes?’ Many benefit providers say they have a \u201cnetwork\u201d or \u201cvetted providers,\u201d but it’s critical to dig deeper and understand the qualifications that make up their vetting process and what is required to ensure your program is delivering top-tier care.<\/p>\n","protected":false},"excerpt":{"rendered":"

Credentialing is much more than a one-time approval; it\u2019s an ongoing process that holds providers accountable for the highest level of care.<\/p>\n","protected":false},"author":45,"featured_media":28328,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[582,440,576,575,609,580,250,577,586,588,581,579,593],"tags":[483,602,251,376],"class_list":["post-28326","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-benefit-trends","category-blog","category-consultants","category-employers","category-expert-perspectives","category-fertility-and-family-building","category-fertility-in-the-workplace","category-health-plans","category-individual","category-labor-organizations","category-maternity-care","category-menopause-care","category-womens-health","tag-b2b","tag-differentiators","tag-premier-provider-network","tag-provider-network"],"yoast_head":"\nWhy Credentialing is the Backbone of Quality Healthcare | Progyny<\/title>\n<meta name=\"description\" content=\"Credentialing is much more than a one-time approval; 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