Things To Consider Before Starting Credentialing Process

Things To Consider Before Starting Credentialing Process

Credentialing is a popular term among providers, especially among physicians who, just ten years ago, could simply perform cash only services. In contrast, nowadays patients are demanding that providers accept their insurances for payment. Hence, those who don't want to lose clients and scare potential patients away should go through the credentialing process.
Getting credentials mean filling out and retrieving multiple applications with insurance companies, then submitting everything to them, and then constantly following up. Even though it may sound simple, many would agree the process is nightmarish as it usually doesn't go smoothly, and many providers have to submit their applications multiple times, spending time contacting insurance companies and fighting delays and rejections. Moreover, many panels can simply say that they don't accept people with your specialty or they are full.
While the credentialing process will never become one of your favorite things to do, there is still something you can do to make the credentialing a bit easier.
Create a list
Research all insurance companies and choose those you want to get credentials from. Each company has its own credentialing process, so be prepared to submit different application forms and go through multiple interviews.
Complete the CAHQ
The Council for Affordable Quality Healthcare, or CAHQ, is usually required to complete the credentialing process. Almost all big insurance companies, like Aetna or BCBS, use CAQH applications. Thus, you should get yourself acquainted with the system.
First of all, you can't simply upload your information on CAQH, you need to be invited there by an insurance company. And if you remember that "chicken or the egg" thing, you can imagine how it feels when you need to submit an application to an insurance company. Once you submit it, you should call them to check if they actually received anything and generated a CAHQ number for you. And then you can go to CAHQ and complete the application that you have already sent to the insurance company, which is waiting for the complete application to arrive.
Never submit CAHQ applications on paper
Even though you can choose to either submit an online application or send it on paper, never choose to send papers. First of all, their application is over 50 pages long. And second of all, when you send your application on paper, CAQH hires a data entry person to transfer your data. And if you think it takes a lot of time...they just never do it. Many physicians have submitted their applications on paper and CAHQ simply lost them. And if you call to CAHQ, they will also ask you to submit the application online.
Devote around 10 hours for each insurance company you want to get credentials from
Don't expect that getting credentials will only take ten minutes of filling out the application. Usually, you need to spend 10 hours of labor for every insurance company. It includes getting and filling out forms and applications, organizing documentations, and checking the process of credentialing.
Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.
©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  All Rights Reserved.