Credentialing and Timeframes

Hey all, this is Loralee Kapp, a Solutions Manager with Managed Outsourced Solutions and today, I want to talk with you about the ins and outs of credentialing and provide you some estimated timeframes for each stage.

So, let’s get started!

00:15 Key Steps in the Credentialing Process

The first step in the credentialing process is gathering all the necessary documentation. This includes your licenses, certifications, diplomas, and other credentials. Make sure you have them readily available before you begin. The estimated time for this 1-2 weeks.

Once you have your documents in order, it’s time to complete the credentialing application or the creation of your CAQH (Council for Affordable Quality Healthcare) Profile. This involves filling out detailed forms with information about your education, training, work experience, and any additional certifications or specialties that you may have. The estimated time for it is 2-3 weeks.

After submitting your application, the next stage is verification. This is when the insurance company or credentialing agency checks the accuracy of the information you provided. They will contact your educational institutions, previous employers, and licensing boards to verify your credentials. The estimated time for this is 4-6 weeks.

During the verification process, it’s common to experience delays due to factors beyond your control, such as slow responses from third parties. However, proactive follow-ups can help expedite this process.

Once your credentials are verified, the next step is to undergo a background check. This typically involves a review of your criminal history, malpractice claims, and any disciplinary actions taken against you. The duration of this process can vary depending on the thoroughness of the background check conducted by the insurance company or agency. Its estimated time is about 2-4 weeks.

Once your background check is cleared, you’ll move on to the provider enrollment stage. This is when you officially become a participating provider in the insurance network. You’ll need to sign agreements, negotiate fee schedules, and fulfill any additional requirements specific to each insurance company. Estimated time for it is 2-4 weeks.

Finally, after completing the provider enrollment, it’s time to get credentialed with each insurance company individually. This involves submitting the necessary paperwork and meeting any additional requirements they may have. The timeframes for this stage can vary widely depending on the number of insurance companies you wish to be credentialed with. Estimated time for it is 4-12 weeks per insurance company.

Keep in mind that these are estimated timeframes and can be subject to variations based on the specific circumstances of your credentialing process, the responsiveness of third parties involved, and any changes in regulations or policies.

So, there you have it—the stages of medical insurance credentialing along with estimated timeframes. Remember, staying organized, proactive, and ensuring accurate and timely submission of all required documents can help expedite the process.

03:18 Why to Outsource Credentialing Tasks?

In addition to the estimated timeframes I just discussed, another option that can significantly streamline and simplify the credentialing process is outsourcing it to a specialized credentialing company. By partnering with an outsourcing company, healthcare providers can alleviate the administrative burden and gain access to a team of experts well-versed in the intricacies of credentialing. These outsourcing companies have the knowledge, resources, and established relationships with insurance companies to expedite the process. They can handle tasks such as document collection, application completion, verification coordination, and even ongoing maintenance of credentialing. Outsourcing allows providers to focus on patient care while the credentialing experts efficiently navigate the complex landscape of insurance networks and requirements, leading to a smoother credentialing process overall.