The Do’s & Don’ts of Provider Credentialing and Enrollment Services

The Do's & Don'ts of Provider Credentialing and Enrollment Services

Medical credentialing is one of the most important steps in creating a financially stable practice.  Making sure that completing your provider enrollment and becoming affiliated with insurance companies ensures that you receive reimbursement for medical services.

Our credentialing team has put together some best practices and what to avoid when getting your practice credentialed.

Do #1 Start Early

The average time frame to credential your physician could take from 3 – 6 months.  Typically the beginning of the year and August/September networks are often behind, causing longer processing times.  We have also learned that some of the larger insurance companies BCBS, Aetna, Medicare/Medicad MCO often take longer.

DO #2 Maintain All Documents

Maintaining all credentialing documents is important. Information is dependent on payers, but tends to be relatively consistent across the board.  Keep your Council for Affordable Quality Healthcare (CAQH) up to date.  CAQH is an informational database that allows networks to easily access provider information in one central location.

Also, make sure that the DEA, NPI number, License and Malpractice information are all up to date.

DO #3 Know Your State Regulations

Each insurance carrier has different regulations and they vary from state to state.  Be aware of what your state credentialing requirements are, this is especially important if you are starting a practice in a new state.

Do #4 Expect Additional Fees

Be prepared to receive additional fees.  DMERC, Medicare, and Medicaid are known to have fees.

A Game Plan for Credentialing

A lack of expertise with credentialing can lead to denied applications or requests for more information, which can extend the time from when a new provider can start and delay delivering services to patients who need them.  Many organizations choose to outsource credentialing to experts in credentialing and Ultimate Billing is that expert.