Not long after beginning my billing service 20 years ago, I begin to hear the complaints of my clients about the dreaded credentialing process!  I have yet to talk to anyone who has enjoyed this task and it was for this reason that I began offering credentialing services to my existing clients.  

I still offer credentialing services today, both to my existing clients and as a stand-alone service.



The Credentialing Process

Credentialing in a nutshell


Most healthcare providers depend on insurance payments for the majority of their revenue.  By completing the credentialing process, you are asking an insurance panel to review your qualifications and determine if you will be accepted as a participating provider.  As an in-network or participating provider, any patient insured through that panel can maximize their insurance benefits.  As an out-of-network provider, your patient would have a much higher out-of-pocket expense.



Why not handle it yourself?

Well, you certainly could handle the credentialing process yourself, but most providers do not want the hassle!  The credentialing process is time consuming and frustrating and I speak from experience when I say that!  Most providers do not want to invest the time it takes to complete this long and tedious process.  Additionally, most providers do not understand or have the knowledge needed to complete the process.  Sure, you could figure it out, but most do not want to take that valuable time away from their practice!  



What can I expect?

If I have said it once, I have said it 100 times, the credentialing process is not a quick one!  Insurance carriers vary widely in their turnaround time; however most complete the process in 90-120 days.  Some panels can take even longer.  Until you have received a fully executed contract or agreement from a network panel, any patient you see will be responsible for the plan's out-of-network benefit level (if this type of benefit is even available). 



OK. I'm in, what's this going to cost me?

I charge by the hour and offer my billing clients a reduced rate.  The rate for billing clients is $25.00 per hour and my rate for non-billing clients is $30.00 per hour.  The total number of hours can vary widely and depends on the number and type of networks applied to.  If you are a new practice just getting started, the average number of hours invested is usually around 30-35.  If you are an established practice and only wish to apply to one or two panels, my time invested will be considerably less.

I bill my clients at the end of each month and include a Time Report that details the work completed.



Do you complete provider updates?

In some instances, providers do not need to apply to networks, but instead to update their information with the networks they already participate with.  For example, address updates, phone updates, etc. I can handle this process as well and charge the same hourly fee.  

If you are changing your TIN, this is normally going to require that you reapply to your existing networks.  


If you would like more information about my billing services, read more about my transparent pricing here.


Final word on credentialing.

While you are considering my credentialing services, here are some important precursor requirements:

  1.  A current and complete CAQH application.  
  2. Your CAQH profile should also include current copies of these core documents:
    1.  License(s)
    2. Certificate of Insurance (proof of malpractice insurance)
    3. Current resume or CV that includes all dates (month and year) along with any explanation of significant gaps in employment.
    4. Copy of highest level of education diploma
    5. IRS form W-9
  3. Other documents that may be required:
    1. Verification of EIN/TIN from IRS.  Commonly referred to as the CP575.
    2. Current business license
    3. A voided business check
  4.  An established service location, phone #, business email, and secure fax #.

Interested in learning more about credentialing services? I would love to hear from you!