Credentialing is the process of adding a provider to a certain insurance company network. Credentialing is essential in the effort to communicate trust and quality to insurance providers who in turn refer patients to your practice making you ‘in-network’.
Credentialing entails verifying the qualifications of the doctors at your practice and doing so on the routine basis. This is often a tedious task and requires high levels of efficiency, accuracy, and available time.
When & Why Your Practice Needs Credentialing Support:
- Adding a new doctor to a practice or adding an existing doctor to a PPO plan – This requires an application to be filled out for each insurance company.
- Multiple Locations – Credentialing a doctor for multiple locations must be completed, depending on the insurance company. Forms must be filled out, signed by the doctor, and administered to the insurance company.
- Re-Credentialing – Re-Credentialing is necessary for most PPO insurance companies, typically every 3 years. Forms must be filled out, signed by the doctor, and administered to the insurance company.
How Credentialing Works
The credentialing timeline is different for each insurance company, as each insurance company has a provider relations department that works at different speeds. It can typically take a few weeks up to a few months, based on the insurance company.
Credentialing should take place prior to the doctor’s start date. Any patients seen prior to the doctor’s effective date will be considered “out of network.” Application forms must be filled out, signed by the doctor, and administered to the insurance company.
We Have Your Practice Covered
The good news is that our credentialing experts can handle this crucial task for you while you focus on patient care. We’re familiar with the communication needed with each insurance company’s provider relations department and can guarantee fast and effective credentialing.
This will remove the delays and headaches of credentialing internally and allow us to fully manage it for you.