MEDICAL CREDENTIALING

Medical credentialing is a necessary evil and there is no easy way around it. Medical credentialing is essential to starting or building a practice and is also required when you choose a new billing company. If done wrong or postponed until a month before your desired start date, it can spell cash-flow delays, scheduling nightmares and unnecessary stress.

The process is tedious and time consuming, especially since the standards for approving a physician’s credentials varies by insurer. The National Commission for Quality Assurance (NCQA) sets the standards for which physician credential approval is based. The NCQA requires primary source verification of a number of credentials, including: education, training, licenses, board certifications, work history, insurance coverage, and malpractice claims history.

Fortunately, there are ways to minimize issues with credentialing.

  1. Pay attention. Complete and sign all documents within five days of receipt. The credentialing time clock doesn’t start ticking until the carrier(s) receive all of the documents. Missing, outdated, or incomplete information are the most common reasons for delay. Getting it right the first time means you’ll get a new provider credentialed within 90 days, for most payers.
  2. Start early. Most credentialing can be done within 90 days but there are some carriers that will take 120 days so plan on 150 days.
  3. Stay current with CAQH. Physicians who regularly update and attest with CAQH find credentialing and re-credentialing much easier.
  4. Gather key pieces of information. Prior to starting the credentialing process you will need a physical office location, phone, fax and a physician’s National Provider Identifier (NPI), and a tax identification number.

When you become a client of Onpoint Medical Solutions we will work with you to finalize credentialing with all carriers. Onpoint makes sure that we get everything needed to submit it right the first time. Physicians must be credentialed with each insurance carrier, Medicare and Medicaid before claims can be filed.