How Long Does Credentialing Take?
I’ve never spoken to a provider who believes it when you tell them credentialing can take up to six months and that predicting the actual date of approval is impossible. It is stressful for everyone when the best you can provide is a hopeful estimate. Generally, the credentialing and contracting process takes 90-120 days from the day completed applications are submitted. We typically see the credentialing process completed in 60-90 days and the contracting phase taking another 30 days. However, some payors will be much quicker, and others will be much slower. So, we always recommend planning for the worst case.
Why is credentialing so slow? After all, doesn’t it seem like you complete an application, submit it and it could be reviewed and approved in a couple of weeks? Let’s take a closer look at the process.
The Credentialing Application
First, you must obtain an application. Some payors require you to submit a letter of interest. The payor will run your Tax ID and NPI number to determine if they will even provide you with an application. This decision depends on how many other providers are in your geographic area providing the same services to their members.
The hard part begins if you are given an application. It can be anywhere from 3 – 400 pages or more. It requires that you have all your medical certificates, CME records, and work history. You will have to explain any gaps in your work history, provide copies of your medical licenses, diplomas, certificates, and proof of medical malpractice insurance. You will be required to answer a series of questions related to you and your practice. Any missing information or documents will result in delays.
Credentialing & Contracting
Once your application is submitted it is reviewed for completeness. They then compare all the information to your CAQH profile for accuracy. Likewise, they will check your licenses, DEA, and malpractice claims history. They will also query the medical board to determine that there is no disciplinary action pending. All of this takes time and unfortunately, the carriers rarely consider that time is money and that they are impacting your practice.
Finally, you receive notification that your medical credentialing has been completed! But wait this doesn’t mean you can start to see patients. This means that credentialing is completed and now your credentialing file goes to the contracting department.
Few providers realize that these are two separate activities. The payor will now prepare a contract. They will assign you a fee schedule and send it all to you for your review and signature. Once you have signed the contract they will upload it to their claims adjudication software. We have seen this take as much as two weeks. When everything is finalized, you will receive what is called a ‘welcome letter’. The letter will have an effective date. This means that you are now credentialed and contracted with the payor, and you can begin to see patients, submit claims, and be reimbursed for services, per your contract.
What Can You Do to Speed Up the Process?
The best answer is timely and accurate completion of the credentialing application. If you are doing the credentialing on your own, then make sure you call to check on the status every week. This is the best way to learn of any missing documents as soon as possible. Lastly, if you are starting a new practice or hiring a new provider for your existing practice, allow an appropriate amount of time for credentialing to be completed. There are no shortcuts, and the process can’t be rushed.
Inhouse Credentialing v. Outsourcing
Credentialing is an art and requires tenacious follow-up. We all wish it were a science because there would be specific guidelines and timelines but that isn’t the case. In our experience, our clients have benefited from outsourcing. Credentialing specialists know what needs to be done and when. They are not trying to juggle any other tasks associated with the practice. Their goal is to get the practice and providers credentialed as quickly as possible. Also, don’t forget there is credentialing maintenance that must be done every year. This isn’t to say you can’t do it yourself but it is sure a lot easier to have it done by dedicated specialists.