Provider credentialing is the process by which an insurance company formally assesses a provider’s qualifications and competency-based on demonstrated competence. Before a provider or organization can bill an insurance company, the provider must first be credentialed by the insurance company. This can be a time-consuming process, and often takes up to six months to complete. The reason for the lengthy process is the requirement for the submission of extensive background information. Depending on the circumstances, the clinic or organization for which the provider is working may also need to go through credentialing.
Tips for Speeding Up Provider Credentialing
- Carefully fill application: A majority of provider credentialing applications have missing, outdated, or incomplete information, which can cause significant delays in credentialing. The most overlooked data are work history and current work status; malpractice insurance; hospital privileges; and attestations.
- Start early: Although most insurance companies estimate 90 days’ time required for the credentialing process it’s no longer adequate. It is best to start your process 150 days in advance to allow for unforeseen delays and setbacks.
- Up-to-date CAQH: Credentialing is generally more efficient for providers who regularly update and attest their information to the Council for Affordable Quality Healthcare (CAQH). Check your CAQH profile to ensure it has all the required information, attestations, signatures, and documentation. Many commercial payers rely on CAQH to retrieve credentialing information. Incomplete profiles will slow down the application process.
- State’s regulations: Providers should know their state’s regulations regarding credentialing. Several states have reciprocity regulations, meaning if a physician is credentialed in one state by a payer, their credentialing in another state for that same payer can be streamlined. Additionally, a physician moving from one practice to another within the same state may not have to go through the full credentialing process again.
- Track credentialing application: Don’t allow applications to fall behind. Ensure that everything moves as quickly as possible. Checking in with insurance companies about the status of each application until the application is complete means staying on top of the process.
- Avoid common errors: In some cases, simple, preventable errors delay the credentialing process. Knowing the common mistakes can be very helpful in order to avoid them. Here are just some of the most frequent oversights and mistakes:
- Work history gaps without explanations
- Submitting an expired DEA license or number
- Failure to provide a complete malpractice history
- Professional references are lacking
- Forms not properly filled out
- Data entry mistakes
Our Credentialing Services
Provider credentialing requires updated knowledge of the payer credentialing process, state regulations, error-free applications, updating CAQH, gathering necessary documents, and tracking application status. Which makes the provider credentialing process tedious and time-consuming. We can assist you with our provider credentialing and enrollment services. Our provider credentialing services include:
- Collecting all the data and documents required for filing credentialing applications
- Store the documents centrally on our secure document management systems
- Communicating with your top payers for updated credentialing requirements
- Applying the payer-specific formats
- CAQH attestations
- Frequent follow-up for tracking credentialing application
With our credentialing services, you will be able to get credentialed faster with all major payers. To know more about our provider credentialing and enrollment process, contact us at firstname.lastname@example.org/ 888-357-3226