Time Required for Physician Credentialing

A healthcare facility’s accountability and overall reputation is dependant upon Physician Credentialing. If there is one administrative task that requires meticulousness and painstaking precision in a healthcare sector, it is physician credentialing. Being a process that is so stringent and directly impacts reimbursements, credentialing is a complete nightmare for those facilities where the administrative staff is not qualified or experienced enough to conduct the background work with the accuracy needed by this process. The challenges that shroud the credentialing process are many, and as a result, most healthcare units struggle to have their physicians credentialed on time and without too much fuss.

How Long Does It Take?

This is the most frequently asked question by our clients who avail of credentialing service. What is the Physician Credentialing Process? How much time is it going to take for the application to be processed? The time taken for this is dependant on many variables that will affect the timeline. Predominantly it depends on the type of enrollment being sought.

Credentialing is a systematic process of verifying healthcare provider’s educational documents, competence, certifications, experience, or status of the current licensure. Insurance carriers, employers, and Hospitals require this background check to decide about provider enrollment.

The credentialing process can take a lot of time because it involves extensive documentation in the first phase and then it depends on how long the payor or carrier would take to check your application. Compared to commercial carriers it is faster to get enrolled with Medicare.

Between 40 to 60 days is the time that it takes to get enrolled with Medicare on average. However, getting registered with commercial carriers can be hectic and can take up to 90 – 120 days on average. There are some other dependencies too that can delay the process.

For example, in some states, physicians need to wait for at least 60 days before submitting their application once their certification is complete. In some states, this is limited to 30 days. Beware that without getting registered any new physicians are not allowed to see patients or provide any type of medical treatment.

Non-credentialed physicians cannot be billed for practices. Any claims submitted on behalf of such a physician would result in denial. Occasionally, claims of a non-credentialed physician are submitted in the name of an already credentialed physician by practices.

However, this can lead to many issues if it is detected during audits and can open up legal actions. In this manner, non-credentialed physicians stay unprofitable for the practices. It highlights the importance of the early start of the new physician credentialing process.

How to Speed Up Physician Credentialing?

Missing information & incomplete documentation are among the main causes that delay the credentialing process. Submitting the application by verifying every requirement and aspect eliminates the unnecessary delays caused by resubmissions and speeds up the enrollment process. Our credentialing experts have mastered this process and can maximize the success ratio by handling the application systematically.

It is of utmost importance to have all the documents ready. It includes the CV of the physician along with education diplomas & certificates, board certificates, licenses. Besides that, National Provider Identifier (NPI), details of the privileges, and if applicable also include valid Drug Enforcement Administration certification.

Collecting the right documents is just the first phase and it completes with the submission of the application. During the second phase, the application verification process begins from the carrier’s end. And the last phase is the approval of the application. We offer a quick credentialing process that enables healthcare providers to cut the time-consuming process through an organized and efficient service.

We have already simplified this process for thousands of healthcare workers and healthcare organizations. We’d process all official procedures and applications on your behalf, contact our credentialing professionals.