Why is credentialing important?
Credentialing is the process of gaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health care organization. Industry-recognized credentials help employers to validate the information and skills of potential employees and save time in selection of the skilled physicians for jobs applications. Medical credentialing is increasingly important because it is the one procedure that allows patients to confidently place their trust in their chosen healthcare providers
What is credentialing process?
Medical credentialing used to take about 90 days – much of that time is spent in queue with insurance companies. However, more recently, insurance companies have been asking for at least 4-6 months. There are a number of items that are requested during the credentialing process for solo and group practices as well as university-affiliated hospitals.
You need to provide good application to various insurance companies. A perfect application should collect all the information needed at one time. It’s also important to make it easy to providers to keep providers data updated so you’re aware of any changes as quickly as possible. Some of the key elements you should be verify with primary sources to verify that information.Â
Provider Education – Sources: American Medical Association or Medical SchoolÂ
- Board Certifications – Source: American Board of Medical SpecialtiesÂ
- Medical License – Sources: State Medical Board or Department of HealthÂ
- NPI – Source: National Plan & Provider Enumeration SystemÂ
- Sanctions – State Sources: Medicaid sanction list in provider’s state of practice
Federal Sources: System for Award Management and Office of Inspector General
- DEA Registration – Source: National Technical Information Service
- Board Certifications – Source: American Board of Medical SpecialtiesÂ
Credentialing is a lengthy process. You can consider outsourcing your provider credentialing to save your practice time and money. If you’re ready to outsource provider credentialing, Medisys Data Solutions, Inc. can help.Â
How Do I Get Credentialed with Insurance Companies as a New Provider?
Some insurance carriers can complete credentialing within 30 days whereas others may take up to 180 days. Get your NPI first as there are two types of National Provider Identifier (NPI) numbers: Individual (Type 1) and Organizational (Type 2). To register for your individual NPI, go to https://nppes.cms.hhs.gov/#/, and follow the process by creating your account.
You need to complete your CAQH application. Several insurance companies now use one application, called “CAQH ProView,” to obtain your information. To complete the CAQH application, go to https://proview.caqh.org/PR/Registration.
If you intend on treating any Medicare beneficiary, which includes seniors and younger disabled people, you must register with Medicare as either participating or as a non-participating provider. You can complete enrollment forms online at their website at http://www.ngsmedicare.com.
Start Billing and Collect your Collection from Insurance Companies
Once you are credentialed you can start billing insurance companies for your practice. Keep your practice up to date can make a big difference for your bottom line and also go a long way to keeping your practice compliant for the long run.
We have helped Start-Ups with Credentialing services. Does your new practice or physician need credentialing services? Let us help you! We’ve helped countless new practices! CLICK HERE to get your free quote now.
