FAQ

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What is Credentialing?

Medical credentialing vets the medical providers such as doctors and nurses are trained and certified with the proper professional experience to provide healthcare services to patients. Be credentialed means the medical provider is holding the highest standard os safety in their line of work. 

Why become medical credentialed?

Being credentialed means you can work with specific insurance companies and bill them directly for your services provided. Which in result mean more patients when looking for providers in network will go to you. By working with insurance panels, allows your patients to pay for services at a lower cost and can also benefits from carrier referrals 

What is the process to becoming credentialed?

Being credentialed means you can work with specific insurance companies and bill them directly for your services provided. Which in result mean more patients when looking for providers in network will go to you. By working with insurance panels, allows your patients to pay for services at a lower cost and can also benefits from carrier referrals 

Do I get to choose which insurance panels I want to work with?

with is entirely up to you. Most outpatient physician providers credential with 7-8 payors, whereas hospital-based physicians (in-patient) usually credential with 10-15 payors (pretty much any patient with any insurance that comes to hospital). Physicians working in tristate area (border of 3 states) like in our physician owner practice credential with 25 payors. Most behavioral health providers, Therapists (PT, OT, ST, ABA etc) typically select 6-7 panels.

How do I know which insurance company is best for me?

The insurance you work with will depend on your needs. Please contact us and we would be happy to go through the options with you.

What is the cost for services?

We offer a variety of rates, based on complexity and size of the company. Which insurance companies are most used? Companies which are most popular would be Blue Cross, Blue Shield, Aetna, Cigna, United Health Care, Kaiser and others.

How long does it take to get credentialed?

In best case scenario the process can range from 90-120 days. After collecting all information needed from you, we submit your applications to your insurances of choice and follow up frequently to make sure the process has no issues and continue to move forward smoothly.

How much time will you save?

Each company chosen will take up to 10 hours.

How many hours of work does insurance credentialing take?

Depending on the licensing type can determine the amount of time. On average for outpatient practices, will take between 10-12 hours per insurance. If an appeal has to be filed, can take an additional 5 hour of work with the insurance. As for facility-based services, home health, DMEs will take over 20 hours to complete the credentialing process with the panels.

Are you guaranteed to get on the panels you apply for?

No. Eligibility for panels involves many factors, including (but not limited to) your location and areas of practice. If you are fully licensed, there should not be an issue with getting credentialed.

How can I track the progress of my applications with companies?

We will provide regular updates every 2 weeks and also provide you login to see the process.

Do I need to wait a certain period of time before I get on an insurance panel once licensed?

As long as you are fully licensed, there will be no problem getting credentialed with no experience in the field.

What is CAQH?

CAQH stands for Council of Affordable and Quality Healthcare. It’s a nonprofit created by the private insurance panels. Most commercial payers require a CAQH profile created before beginning the credentialing. Panels use CAQH to verify providers personal information as well as education and work history.

When does credentialing and recredentialing occur?

Credentialing happens before the provider is considered to work with insurance networks. Recredentialing is done every 1-3 years after original date of the provider to ensure the information is up to date for insurance panels. 

How to obtain a CAQH ID number?

Majority of insurance companies will require a CAQH ID. If you do not have an ID, we would be happy to help you fill out an application or you can visit the CAQH ProView to begin the process.

How long does CAQH last?

It lasts every 4 months and will need to re-attest all information on the application is correct.

Can you negotiate rates?

Yes, for all insurance payors except Medicare and Medicaid. They do not allow any negotiations.

How long does insurance contract negotiations take?

It can take between 4 weeks to 3 months. Some payors can take even up to 6 months depending on the payor. If you don’t agree on the proposed rates, going back and forth with the payors can take between 9-12 months.

How long should I be credentialed with a payor before I try to negotiate?

negotiate rates, our recommended time would be during the recredentialing period. You can all negotiate during the initial credentialing process with some payors.