13 Nov

Credentialing and CAQH Completion

One of the most important pieces to opening a new practice, or moving from one practice to another, is your payor Credentialing. This is a time intensive process most providers or office managers do not have the bandwidth for. This is where outsourcing your credentialing can be critical.

You typically want to allow a minimum of 90 days prior to your practice opening, or move, to begin your credentialing process. However, the earlier you start, the better. Some payors can take 4-5 months to complete the credentialing process.

Medicare is where it all begins. If you’re going to be accepting Medicare patients, you must start here. Medicare can be one of the most detailed and specific applications you fill out. Your circumstances dictate which form or forms you have to use. These forms need to be carefully filled out and signed by the provider before being sent in. It is best to follow up to ensure the forms are received, then follow up again every allotted time suggested by the Medicare personnel you talk to when you status the application. If a box is missed being checked, or an NPI number is off by one digit, you’re starting the process from scratch. It may take more than one application to get the Medicare credentialing complete.

Once you’ve received your Medicare number, you can start applying for other payors. Medicaid would be your next big step, if you will be accepting Medicaid patients.

Commercial payors each have their own application process and you will need to be sure to follow each application procedure precisely. Some payors can use your CAQH information to process your credentialing. United Healthcare typically does this. You only need allow them view-only access to your CAQH page, and they’ll take the rest from there.
It sounds simple enough. But where the time and labor-intensive piece comes in is with the follow ups. Payors are notorious for letting credentialing applications linger through the process. You need someone that can regularly and routinely follow up on the applications, as well as escalate matters if your application is running into any roadblocks. Most providers do not have someone in their office that could do this follow up based on their regular daily duties.

Considering an outsourced consultant to take care of this will ensure you will be paid correctly and timely based on your start date.

Donna White

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