Physician credentialing or provider credentialing is a prolonged yet crucial procedure. Every physician who joins a new practice requires credentialing. It is a process of acknowledgment, attestation, and authentication of knowledge, proficiency, and motivation of the physician to provide medical care.
If postponed for a long time or done arbitrarily, it can cause glitches in payments (delayed or denied) and scheduling issues. Also, it is difficult for the physician to start practicing and generating revenues.
Here are a few facts that can help accelerate the practice:
1. Apply early:
Start the credentialing process as soon as you are hired to join another practice as responses from references can take a while. Give enough time (90 to 150 days) for the complete process to ensue. This is mostly so because the application process is payer dependent as payers have their own procedures to be followed.
2. Key factors:
Ensure that all details are completely filled in and not outdated. Obtain a checklist of the information and documentation required from your end to avoid missing out on any information; details include work history (previous and present dates), malpractice insurance, perks and coverage information, start date, and attestations.
3. CAQH:
Regularly update and get your status attested with the “Coalition for Affordable Quality Healthcare’s” uniform credentialing program as it makes the credentialing and re-credentialing process an effortless task.
4. State’s regulations:
Many states have their own credentialing programs such as reciprocity regulations and in-state credentialing. Contact the medical society or the states’ Medical Group Management Association for using the state’s standard which can work to your advantage. The credentialing process for physicians trained in the state is easier than those trained outside.
5. Negotiate delays:
Negotiate with other players in the market for expediting your application process. This could include working with the licensing board to expedite new licenses. You can request your MCO (Managed Care Organization) to ask MSO (Management Services Organization) to do one-time credentialing which avoids delays and duplication of costs.
6. Sustainable Process:
As re-credentialing is always in close proximity, maintain a workflow of documentation and forms. Create a spreadsheet of a list of hospitals, payers, and other third parties that require to be kept informed. Keep note of the prerequisites for submissions and deadlines.
Engage an employee who can keep a constant check of this process and takes action to get forms duly signed along with gathering the necessary information. Purchase or lease credentialing software or outsource the process to a vendor specializing in credentialing. Regularly monitor the efficiency of your process.
7. Provisional steps:
As per some payers, you can use a –Q6 modifier that allows the billing of the new physician as a locum tenens. Get patients temporarily assigned to another physician on the condition that patients will be added back to your panel once you have gained credentials. Use retroactive reimbursements policy and request for temporary privileges.
The credentialing process is long and strenuous. Make it painless by supplying all the relevant information the first time.
