"How long will it take to get me credentialed?" is the most often requested question. The true answer is that there is no way to know. We do follow a set of established criteria that tell us it might take 90-120 days. However, depending on your specialty, certain payors will process your claim significantly faster than others. We'll look at what happens during the credentialing process in more detail below. Knowing these facts will help you appreciate why medical insurance credentialing may be a time-consuming procedure and why it is best conducted by professionals in medical and physician credentialing services.
How to Get the Application
Submitting a payor enrollment application can be a daunting undertaking. Depending on your profession, it might be difficult to tell which application is the correct one to fill out. When you receive the application, it might be anything from 3 to 300 pages long. Some applications are much longer than that. A letter of interest to the plan is frequently required only to receive an application. When they get your letter of interest, they check your Tax ID number and NPI against their database to see whether you are eligible to join their network. This choice is influenced by how many other providers they have registered in the same geographical region and specialty as you. If you are fortunate enough to obtain an application, the difficult part begins here.
To complete an application, you must have all of your medical insurance credentials, degrees, CMEs, insurance, and employment history in one place so that you can swiftly assemble the answers to each question on the application. The application will request information such as every job you've ever had and the dates you worked there, an explanation for any gaps in your work history, copies of all medical licenses you possess, and degrees and certifications. This only scratches the surface. The application will inquire about your criminal background, malpractice history, and civil suit history. It will next request details about your company's ownership. These inquiries continue indefinitely. Any incorrect answers to these questions might bring you in front of the medical board.
After submitting the application and providing all needed documentation, you must actively follow up. Even if a payor says it would take 90-120 days to process your claim, you should nonetheless follow up on a weekly basis. That way, if something is missing from the application or if the payor requires clarification, you may supply it right away. The worst thing you can do after submitting an application is sit and wait. Stay proactive and on top of the process.
CAQH After you submit your application, the payor verifies all of the information on your application to your CAQH profile. This implies that any differences will cause your application to be delayed.
Licenses the payor will also inquire about the status of all of your licenses, from your DEA to your medical license and everything in between. This involves searching a database for any and all malpractice claims histories. They will also contact the medical board to confirm that your license is valid and active and that there are no outstanding disciplinary measures.
Hooray! You've been notified that your medical insurance credentialing is complete. STOP RIGHT NOW! Start visiting patients and filing claims as soon as possible. Contracting comes after physician credentialing. This implies that the payor must draught a contract, have you sign it, and assign you a fee schedule. Once signed, the contract must be uploaded to their claims adjudication program. This might take many weeks at times. Never start seeing patients or filing claims until you have received notification of your effective date, an executed contract, and confirmation that your contract has been posted to their system.
The world of medical credentialing and contracting may be frightening. It might take up more time than you anticipated. Mistakes can cause delays, and certain errors will completely destroy your program. Quality credentialing and contracting are critical to your income. The best approach is to leave these delicate things to medical insurance credentialing specialists.