The Credentialing Process

Things YOU need to have before we can start:

  • A practice location that you don’t plan to change anytime soon. Changing during the credentialing process is not possible and we’ll have to charge an extra fee to do it after that, so be sure of your location!
  • Tax ID number. Do you plan to use one? If so, you’ll need one prior to starting. If you want to use your SSN, that’s ok too.
  • Malpractice insurance with limits of a minimum of 1 million/3million
  • NPI number. You can get one here: https://nppes.cms.hhs.gov

THEN once you are signed up:

  • First things first, we will need to get all of your information such as your practice demographics, license, malpractice insurance policy and other supporting documents.
  • We will generate your CAQH account for you. If you already have one, we’ll check it to make sure it is current and doesn’t have any red flags that may slow down or invalidate your credentialing.

Time it takes: This depends on you!  We move fast to get your CAQH account generated and attested, but its up to you to get us the required information.  For most of our clients, this process takes about a week. 

Next up: Determine which companies you want to apply for

We’ll then have a discussion of which companies you’d like to apply for.

Decisions to make include:

  • Which companies are you eligible to apply for?
  • Are your goals more oriented toward bringing in patients or refining your practice for bigger profits?
  • Are there companies in your area that many of your patients may have that you should apply for?

These are the types of discussions we can have to determine what insurance companies will be best for you.

Time it takes: Usually about a day for our discussion/back and forth to determine what’s best for you. 

Finally! We’ll submit your applications!

We will submit your applications and supporting documents to each company you’ve approved.  After that, we’ll follow up:

2 weeks in we’ll call and make sure they got your application.

1 month and regularly after that in we’ll call and make sure that things are going smoothly and if not, provide them with any thing they need.

Once you are in network, we’ll confirm the effective date and confirm that they got all of your information correct and if not, we’ll send in all of the paperwork to fix it.

Time it takes: This depends on a few things.  You’ll need to let us know when you hear from the insurance companies for any reason.  If you are on top of that, it goes much faster.  Otherwise, we’ll be a bit at the mercy of the insurance companies but typically they take from 90-180 days from the time they receive the application to process your application and send out contracts.

In short, we work as fast as we can.

We want you in network as soon as we can make it happen, so you can start offering this benefit to your patients.

If you are interested in credentialing with us, please contact me. I will be happy to discuss the options available in your state.