Do I Need Separate Credentialing for Telehealth?

Virtual care has changed the way healthcare works in a big way over the last few years. As more doctors and healthcare providers start offering telehealth, one question keeps coming up… Do I need separate credentialing to practice medicine virtually? The short answer is no, but the longer answer is a bit more complicated. It depends on where your patients are located and which insurance companies you choose.

What is Telehealth Credentialing?

Let’s start with the basics. Credentialing is how healthcare organizations, insurance companies, and hospitals check that you’re qualified to provide medical services. They look at your education, training, licenses, work history, and certifications. Think of it as a background check that proves you’re qualified to treat patients.

When it comes to telehealth, things get a bit more tricky. You don’t need a completely different set of credentials to practice virtually, but you might need extra licenses and approvals. This depends on where your patients live and which insurance plans you accept.

State Licensure: The Foundation of Telehealth

Here’s where it gets interesting. In the United States, medical licenses come from individual states, not from the federal government. This means you usually need a medical license in the state where your patient is located when you see them, not where you are when you do the video call.

Let’s say you’re a doctor licensed in California, and you’re doing a telehealth visit with a patient who’s at home in Arizona. You would need an Arizona medical license to provide that care legally. This rule has been one of the biggest roadblocks to telehealth growth.

But there are some ways around this. The Interstate Medical Licensure Compact (IMLC) makes it easier to get licenses in multiple states. If your home state is part of the compact, you can use a faster process to get licenses in other states that participate. Right now, more than 40 states are part of this compact, which makes it much easier for doctors to practice telehealth across state lines.

During COVID-19, many states temporarily relaxed their rules to let out-of-state providers treat their residents through telehealth. Most of these temporary rules have ended, but they showed that more flexible approaches to telehealth licensing are possible.

Hospital and Health System Credentialing

If you work with a hospital or health system that offers telehealth, you’ll need to go through their credentialing process. The good news is that many use something called “credentialing by proxy,” which cuts down on paperwork.

With credentialing by proxy, if you’re already credentialed at your main hospital, another facility can accept that credentialing when you provide telehealth services to their patients. This is common in rural areas where specialists provide remote consultations to patients at smaller hospitals.

However, not every organization accepts proxy credentialing. Some want a full application even if you only see their patients through telehealth. This usually means submitting detailed information about your work history, going through background checks, and showing proof of malpractice insurance.

The Joint Commission (the group that accredits hospitals) has specific rules for credentialing telehealth providers. These rules allow for proxy credentialing but also set requirements to keep patients safe.

Insurance Company Credentialing for Telehealth

This is where many providers spend a lot of time and energy. Each insurance company has its own provider network. You must be credentialed with an insurance company to get paid for services you provide to their members, including telehealth services.

The good news is that you usually don’t need unique credentialing for telehealth if you’re already in an insurance company’s network. Most insurance companies see telehealth as just another way to deliver care, not as a separate type of service. If you’re credentialed to provide primary care or psychiatry in person, those same credentials usually cover you for providing those services virtually.

Medicare and Medicaid

Medicare has expanded telehealth coverage a lot, especially after the pandemic. To provide telehealth services to Medicare patients, you must be enrolled in Medicare as a provider. This is the same enrollment that lets you see Medicare patients in person. You don’t need separate enrollment just for telehealth.

However, Medicare has specific rules about where the patient and provider can be located, which services can be provided through telehealth, and how to bill for them. These rules keep changing, so you need to stay up to date.

Medicaid is different because each state runs its own Medicaid program. Some states have strong telehealth coverage with few barriers, while others are more restrictive. You’ll need to be enrolled as a Medicaid provider in each state where you want to treat Medicaid patients through telehealth. You also need to know that state’s specific telehealth rules.

Different Specialties Have Different Rules

Different medical specialties have different credentialing needs for telehealth. Mental health providers often have more flexibility because many states have special rules allowing telepsychiatry and teletherapy across state lines. Some states participate in the Psychology Interjurisdictional Compact (PSYPACT), which works like the IMLC but for psychologists.

For specialties like radiology or pathology, where doctors review images or samples remotely, the credentialing requirements might be different from specialties that involve direct patient care. Many radiologists have been reading imaging studies from different locations than the patient for years, and there are established ways to do this.

Technology Platforms

If you’re providing telehealth through a third-party platform or service, they might handle some credentialing for you. Many telehealth platforms credential providers and then contract with insurance companies at the platform level. But you’re still responsible for keeping your individual licenses current and making sure you’re legally allowed to practice in the states where your patients live.

Some platforms let you work only in states where you’re already licensed, while others might ask you to get more licenses so you can see more patients.

Steps to Get Started with Telehealth Credentialing

So what should you actually do if you want to start offering telehealth?

The Paperwork Problem

Let’s be honest. Credentialing takes a lot of time and can be frustrating. Applications can take 90 to 180 days to process. Each insurance company has different forms, requirements, and ways to submit applications. For providers who want to offer telehealth in multiple states and with multiple insurance companies, the paperwork can quickly become overwhelming.

This is where many providers need help. Managing credentialing across multiple states and insurance companies takes dedicated time and careful attention to detail. Many practices find that the cost of mistakes or delays in credentialing (like not being able to bill for services) is much higher than the cost of getting professional help.

What’s Coming Next

The telehealth world keeps changing. There’s ongoing discussion at the federal level about making telehealth licensing and credentialing more uniform across states. Some proposals would let providers practice telehealth across state lines more easily while still protecting patients.

For now, providers need to work within the current system. This means carefully tracking licensing requirements, keeping credentials current, and following both state and insurance company rules.

Summary: Credentialing for Telehealth

To answer the question directly: you don’t usually need a completely separate credentialing process for telehealth. Yet, you do need to make sure your existing credentials cover the services you want to provide and the locations where you want to provide them. This often means getting additional state licenses and checking that your insurance contracts allow for telehealth in the areas you want to serve.

The key is to be proactive about telehealth credentialing. Before you start seeing patients virtually in a new state or through a new insurance plan, make sure you have all the necessary approvals. The consequences of practicing without proper credentials can include denied payments, legal problems, and even action against your license.

At Medwave, we know the challenges providers face with credentialing, billing, and payer contracting, especially as telehealth continues to grow. Our team specializes in managing these tasks so providers can focus on what they do best: taking care of patients. Whether you’re just starting to explore telehealth or looking to expand your virtual care to multiple states, having the right support for credentialing and payer contracting can make all the difference in building a successful telehealth practice.

The bottom line is that telehealth offers great opportunities to expand access to care and reach patients where they are. But it requires careful attention to credentialing requirements. Taking the time to get these details right from the start will save you headaches and protect both you and your patients down the road.