Contracting and Credentialing

Contracting with Third Party Payers (i.e. Medicaid and Commercial Insurance Providers)

Have you updated your existing contracts to include provision of STD services?

Most STD clinics already have contracts with Medicaid and commercial insurance providers to bill for immunization or HIV services. These contracts can be re-negotiated to include STD services and/or enhance the current amount reimbursed for these services based on a recent cost analysis. STD clinics must be able to contract successfully with third party payers to become part of their provider network.

Click here to view resources on contracting.


Are you familiar with the process of credentialing/ re-credentialing your clinical providers?

One of the requirements necessary for contracting with third party payers is credentialing clinical providers. Credentialing is important because it demonstrates that your clinical providers are qualified to provide STD services to your clients. It includes providing the third party payer with documentation verifying the clinical providers' credentials to practice in your state.

STD program leaders must ensure their clinical providers for STD services are credentialed or re-credentialed.
Re-credentialing is required every three years. 

Click here to view resources on credentialing.

Credentialing Requirements for Provider Network Participation

  • Licensure and NPI Number
  • Resume and Work history
  • Education and Training
  • Hospital affiliation
  • Medical Practice History and Coverage
  • Physician/Provider specialties/Board status

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