Credentialing

Without successful credentialing, provider reimbursement for medical services can be delayed or, even, denied.

One of the most critical steps a provider can take before they start seeing patients is to become credentialed with major payors. While not every payor requires a provider to be credentialed before they begin to see patients, many of the major payors do. This includes Medicare, Medicaid, BCBS, United Healthcare, Tricare and more.

Credentialing can be a tedious and time consuming process that takes weeks of follow-up and constant attention to stay on track. Most credentialing processes take anywhere from 60 – 120 days, depending on the payor, so be sure to keep this in mind when hiring on a new provider or starting up a new office or clinic.

Provider credentialing is more than just another form to fill out or a minor nuisance. It’s a complex, ongoing process and a critically important one, at that. Given its many steps, critical deadlines and uncertainties, provider credentialing is business critical for your practice.

Also keep in mind that contracting with commercial payors for the first time is a very time-consuming process. Most commercial plans require contracting and credentialing, which slows down their timeline for approval even more.

Legacy can handle credentialing for a new physician or mid-level provider or the ongoing re-credentialing required by most payors. We can also handle the facility contracting, CAQH setup, ongoing quarterly CAQH maintenance as well as hospital privileges, if needed. CAQH is an online database that facilitates faster processing for re-credentialing and holds physician supporting documentation, but must be kept current in order to be useful.

Credentialing is an integral part of the revenue cycle and if providers are not enrolled correctly, they will not be paid correctly, if at all. Everything that we do, is focused on helping our clients take control over the credentialing life cycle and to generate more cash, faster. Helping clients grow operationally and financially is our passion. Contact us to discuss the return on investment (ROI) for your group or individual clinician.

Let our Consultants take on this process for you to ensure it is complete by the time you are ready to see patients – preventing any delays in billing.

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