Credentialing your physicians and obtaining contracts with payors are critical steps to expanding your care ability and access to new patient lives in your area. However, they’re not simple processes, which means you need the organizing tools and protocols to ensure you’re thorough and correct the first time to avoid delays in getting your practice up and running.
What is Credentialing?
Physician credentialing is the process by which you verify individual physicians and other healthcare professionals are capable of performing the services they offer. This involves submitting the following information to regulatory agencies and insurers:
- Licensure materials
- Diplomas (Med school, residency programs, etc.)
- Criminal background
- Health status
- Board certifications
- Any sanctions or other actions taken by professional organizations or licensing boards
Depending on the speed of delivery and efficiency of your in-house team in connecting these materials with payors, the credentialing process can take anywhere from 60 to 120 days.
Documents and Information Needed for Credentialing
When we credential physicians for payors, we have a well-documented process that gathers the necessary materials and contacts the right institutions and agencies quickly. Information we need to credential physicians includes:
- Provider start date at practice
- Practice and billing address along with Phone and Fax #
- Copy of state license
- Copy of DEA
- Copy of degree/diploma
- Copy of driving license
- Provider birthdate and SSN
- NPI #
- Updated CV or employment history
- NPPES login credentials
- CAQH login credentials
- Group Name
- GNPI & Tax ID
- Signed W9
Being consistent in responding to payors requests and contacting them for confirmation can help speed up the credentialing time. This keeps you up-to-date on outstanding information and enables you to address errors if they arise.
Updating Credentials
Payors may require physicians to update their credentials on a regular basis, or they may need to be updated due to changes in the physician profile. This means that your team needs to constantly be aware of potential changes so they can submit them when they arise. This includes name and address changes, additional certifications, or health plan changes they may make. All this means it helps to have a team that’s constantly monitoring your information and can make the updates when needed so you don’t have to worry about anything hindering your reimbursements or payor contracts.
PayrHealth is your partner for credentialing and revenue cycle management to make sure every visit runs smoothly from services rendered to final payment, including keeping credentials updated and in compliance with payor standards.
Outsources Credentialing and Contracting Services
As experts in the industry and with revenue cycle management, PayrHealth provides efficient, scalable solutions for your ongoing credentialing and contracting needs with payors. Gain valuable insight and data-driven results with our experience on your side. Negotiating contracts and keeping your physicians’ credentials up to date are complex tasks that benefit from decades of collective experience. Find out more about these processes and learn how to do them well by calling our team or contacting us online today.
