Medical credentialing is unfortunately a time-consuming task for any healthcare provider. Healthcare credentialing has many benefits to your patients, including ensuring against fraudulent credentials and verifying that healthcare providers can provide services. The general timeframe for healthcare providers to complete credentialing is between 90 to 120 days. However, this is an average estimate. Some payors may complete the process quicker, while others might take longer, especially for certain specialties. The length of time can also vary based on whether you complete the manual process of credentialing or do it online – and whether you maintain an organized process or not. If your healthcare professionals spend significant time on physician credentialing, it can cut into their time treating patients. Here’s what to know about the credentialing process, how to shorten it, and how professional medical credentialing by a healthcare industry expert can help.
Provider Credentialing Process: Step-By-Step
Medical credentialing isn’t difficult, it’s just tedious. Here’s a step-by-step guide to how healthcare provider credentialing works at each level.
Obtaining Your Provider Credentialing Application
The initial step in the credentialing process is acquiring the application, which can vary significantly in complexity. The length of these applications ranges widely, from a mere few pages to extensive documents spanning hundreds of pages. In certain scenarios, a preliminary step involves submitting a letter of interest. This involves reviewing your Tax Identification Number and National Provider Identifier (NPI) against the payor’s database. This review is crucial as it assesses your eligibility to become an in-network provider, taking into account the saturation of providers in your geographical area and your specific medical specialty. Successfully navigating this step and receiving an application begins a more challenging process.
Completing Your Credentialing Information
The application process requires exceptional organizational skills. You’ll need to gather and prepare a comprehensive set of documents, including medical certificates, academic degrees, continuing medical education (CME) credits, policy documents, peer references, and a detailed work history. The application probes into various facets of your professional background, including employment history and any gaps therein, criminal records, past malpractice incidents, and civil litigation history. Questions regarding the ownership of your medical practice are also typical. The importance of accuracy at this stage cannot be overstated, as any discrepancies or incomplete information can have serious repercussions, potentially leading to investigations by medical boards.
Because physician credentialing is a reoccurring event, it’s recommended to keep these documents and information in a single place that is easily accessible when the time comes to credential again. Keeping careful notes about your peer references, board certifications, licensing agencies, and any supporting documents can help you save time going forward. Find a credentialing process that works for you – or consider getting professional help from a healthcare industry expert.
Submitting Your Application
The journey doesn’t end with the submission of your application. Proactive follow-up is crucial. Despite payors often quoting a processing time of 90 to 120 days, it’s advisable to check in every week. This consistent engagement helps identify and rectify any errors or omissions, thereby avoiding unnecessary application processing delays. Keep in mind that if there are delays in your credentialing process, it can impair your ability to practice medicine in the meantime.
CAQH Review
After submission, the payor performs a comparative analysis between the information provided in your application and your profile maintained by the Council for Affordable Quality Healthcare (CAQH) and the National Practitioner Data Bank. Any inconsistencies or discrepancies found during this step can result in delays, necessitating further clarification or documentation.
License Verification
A critical aspect of the credentialing process is the verification of your professional licenses. This includes a comprehensive check of all licensures, from your DEA registration to your board certification to your medical license. The payor thoroughly reviews your malpractice claims history and checks against licensing boards to confirm the current status and validity of your licenses, ensuring there are no ongoing disciplinary actions against you.
Contracting
Upon completing the preceding steps and accepting your application, the process transitions to the contracting phase. Here, the payor prepares a contractual agreement for your review and signature. Following this, you await the notification of your effective date and the confirmation that your contract has been integrated into their system. This final step is pivotal as it officially enables you to start seeing patients under the payor.
Healthcare Credentialing with PayrHealth
The physician credentialing process is intricate and depends on several factors. Understanding each step, from application to contracting, is crucial. With experienced guidance from PayrHealth, navigating this process becomes more manageable, ensuring that healthcare providers can focus on their primary goal: delivering quality patient care.
At PayrHealth, our journey is built on integrity and trust. We understand the complexities and nuances of the credentialing process and are dedicated to assisting healthcare providers in partnership with a variety of health insurance companies and healthcare organizations. To learn more about the provider credentialing process and how our team can help, contact us today for a free consultation.
