Credentialing
Credentialing is a necessity for providing medical care that requires insurance reimbursement. It is imperative that all medical providers and facilities complete the credentialing process when they make any changes to their service location and payers.
Credentialing can be a lengthy process. The process can take anywhere from 3 to 6 months. Knowing this information can help you prepare for provider and location changes/updates.
The Council for Affordable Quality Healthcare (CAQH) is a database that allows the providers to upload all information pertaining to their medical career. The Payer will obtain the necessary documentation from CAQH to start the credentialing process. All documentation needs to be completed properly. Missing information can delay the process.
Recredentialing typically occurs every 2 years and requires a provider to repeat the credentialing process. Providers will receive a letter letting them know that they are up for re-credentialing. If they do not complete this within the given timeframe, they are no longer consider in-network with the payer. Their enrollment with the payer is suspended until the process is completed and approved.
Some of the important items needed to start the credentialing process are listed below.
DEA
Resume/CV
Practice Address
Tax ID
NPI Number
Education
Professional Liability Insurance – past 10 years
Professional Certifications
Work History – prior 10 years
Malpractice Claims History
Delays in the credentialing process can have a huge impact on your overall revenue cycle. Your credentialing team should monitor the progress of your application and immediately contact the provider relations department if there are any issues that slow down the process of being enrolled. Providers should not render medical services to the insured patient until they have received confirmation from the payer with an effective date.
If your organization needs assistance with the credentialing process, please feel free to contact C & T Healthcare Revenue Solutions at (888) 208 – 4227 or by email at info@cthcrs.com. One of our team members would be delighted to speak to you in greater detail regarding how we can be of assistance.