Medical Credentialing is a process whereby insurance networks check to make sure that the provider meets the standards set out by the insurance company. In this process, they review a range of documents including medical licenses, malpractice insurance, schooling information, and background checks. Credentialing is performed on an individual state-to-state basis.
Whether you are adding a new doctor or opening your own practice, you need to start the credentialing process in advance to avoid potential problems. Provider credentialing an essential part of making sure your practice gets paid. If you ignore the significance of the credentialing process you will experience delayed cash flow, difficult scheduling because of patient restrictions, and repeated phone calls to and from payers.
Unfortunately, sometimes the actual credentialing process can be time-consuming and frustrating for everyone involved.
However, there are a few ways that will simplify the credentialing process:
1. Get credentialed early on:
Timeframes vary from three to six months, depending on payer and location. For example, at the beginning of the year, more doctors submit applications, and due to that influx credentialing can take up to five months. It’s important to be aware that this waiting time can affect your practice so get an early start.
2. Make a good provider application:
First, make sure you begin with a good provider application. The application is the very first step in this process, and it requires providers to provide personal, educational, and practice information. A good application should cover professional credentials, where they have practiced, professional experience, and more.
3. Crosscheck the filled information:
After completing the application for the credentialing process, take time to verify the information filled. Make sure to keep all your documents up to date. Ensure these documents are up-to-date: Council for Affordable Quality Healthcare (CAQH), Drug Enforcement Authority (DEA), CLIA Certification, Any other ancillary services that require proof of accreditation, IRS Letter Confirmation of Established Tax ID Number, Articles of Corporation (LLC, PA, INC., etc.), License, Malpractice Insurance. If any of these documents have to be renewed annually, then ensure the document submitted to you by your physician is still valid. Malpractice expires annually, for example, so making sure it’s up to date will help you in the process.
4. Conduct own background check
Many practices choose to conduct their own background check on new physicians, including verifying training, licensure, and employment history before making an employment offer. It may seem like overkill, but it can prevent hiring a physician only to run into problems with licensure later on.
5. Send applications for review:
Once you’ve thoroughly gone through forms yourself, send applications in for review. Just keep in mind that there’s usually more to credentialing than sending in your forms and then waiting for approval. You’ll need to continue to answer questions and provide any additional information needed promptly or you may face rejection.
6. Give adequate references:
Hospitals and other health systems often require three professional references before approving a medical practitioner. Make sure that all references must be physicians of the same specialty who are not related by blood or marriage, and none of the references may be members of the physician’s practice. However, the credentialing specialist who verifies the validity of these references will not waste time following-up a reference on file who is unresponsive. So, if you have listed only three references but one of them is hard to reach, it is most likely for your application to have a longer processing time.
7. Follow up with insurance companies:
Write in dates for tracking and follow up. Regularly call and verify the status of the application to make sure you keep the process going. Some due diligence on your part can ensure the application gets through the process as quickly as possible.
8. Expect plenty of time for the credentialing process:
While credentialing “should” take around 90 days, smart practices give themselves more like 150 days. Credentialing with payers must take place on their timeline, and each has its own credentialing timeline. Assume credentialing will take 150 days, and hopefully, you’ll be pleasantly surprised when it takes fewer.
9. Consider outsourcing provider credentialing:
You may want to consider outsourcing provider credentialing to save your practice time and money. In fact, working with good credentialing service can often take weeks off the approval time by managing the process for you. Credentialing services already have established contacts within insurance companies, and they can save you from frustration and rejections. While outsourcing your credentialing is an investment, which allows you to begin billing and pulling in revenue faster.
Understanding how credentialing works can make a significant positive difference in how smoothly a practice runs and the pace of cash flow. Problems with credentialing can be expensive and drain productivity, so it’s important to have a process in place and a plan for ensuring credentialing always remains up to date.
Our credentialing team helps your practice complete all your required applications, manage your CAQH profiles and network contracts (including negotiations). We can also help you to expand your business by providing credentialing services at any new locations you have. To learn more about how we can help your practice with credentialing, medical coding, or medical billing, contact us today on 888-357-3226 or firstname.lastname@example.org