If you are running a healthcare practice then you must be familiar with all aspects of the healthcare system or processes. Some happen quickly while the same takes time to manifest. Credentialing is one of the most significant and critical steps of the onboarding process of healthcare professionals. Credentialing is also named as provider credentialing, medical credentialing and physician credentialing. This process involves the complete verification of healthcare providers to ensure that they meet the requirement of delivering quality services or not. However, it’s a time-consuming process and can take more time than healthcare providers usually expect. If you want to know more about how long credentialing takes and what are the main factors that can delay the process of provider credentialing then read this article. You will also explore those top ways that can elevate the speed of the credentialing process. So let’s get started!
How long does it typically take to Credential a Provider?
Physician credentialing offers multiple benefits for both patients and healthcare providers. This process makes sure that all the credentials of professionals are accurately verified so patients can receive quality care. Credentialing experts can also detect fraudulent credentials so it never affects the integrity of a healthcare practice. Moreover, if the credentialing process is faster then patients can quickly get their desired quality care without any delay. Ultimately, healthcare providers can get their reimbursements on time.
The time that the credentialing process takes depends on several factors. Usually, the entire process takes approximately multiple weeks to months to complete the credentialing process for healthcare providers. Generally, the provider credentialing timeframe is approximately 90 to 120 days. But always remember that this is an average estimation. The exact time frame of provider credentilaing depends on multiple factors which include:
- The efficiency of the organization’s credentialing
- Accuracy and efficacy in provider documentation
- Complexity in the background of the provider
- Mode of credentialing
Normally, the estimated approval time in credentialing is as follows:
Credentialing for Medicare and Medicaid: 40 to 60 days
NPI application: 30 minutes
Initial vs. re-credentialing times: 90 to 150 days /45 to 90 days
Commercial insurance carrier credentialing: 60 to 90 days ( 30 days for contracting)
Online CAQH application: 3 hours
The process of provider credentialing should take less time. If healthcare providers are only spending their valuable time in credentialing then they cannot pay attention to their patients. This will also result in a negative effect on the revenue stream of a healthcare organization. If the healthcare providers are not approved based on the requirements of credentialing then they can not offer their services. This means that the healthcare organization can not benefit from their professional skills. Therefore, the process of medical credentialing should be robust and proficient which helps healthcare providers to achieve their goals.
Which documents are required for the Credentialing?
The first step of healthcare provider credentialing involves the verification of all documents submitted by the healthcare providers. Credentialing specialists take this responsibility and rectify every single document. They also perform the primary source verification for better determination. In the initial step, the following documents are verified as they are essential for credentialing.
Application
The initial application is just a form that gathers the entire information including personal details such as contact information and other details of personal background. Credentialing application processing time is diverse.
Education
Providers are required to submit the documents of their education including certificates, diplomas etc.
Personal identification
This includes the passport, driving license as well as the social security number.
Professional documents
This involves the board certificates, medical licenses and their related registrations etc.
Previous work history
They also provide information about their previous responsibilities including professional organizations, date of employment and job descriptions.
Malpractice insurance
Other than documents, providers also provide proof of malpractice insurance coverage.
DEA registration
If the healthcare providers make recommendations of controlled substances then they are required to submit the registration details of the Drug Enforcement Administration (DEA).
Criminal record
Credentialing experts also check if there is any criminal record of a professional or not to prevent any kind of mishap in the future.
What are the main steps involved in provider Credentialing?
The main steps in the credentialing process are as follows:
Gathering information
The first step involves collecting the credentials which are required for the credentialing. The complete information of the healthcare providers is gathered. Moreover, other information involves the physical address, mailing address, group or individual National Provider Identifier (NPI), clinic fax number, Tax identification number Master Provider index etc. The timeline of this step usually varies but generally revolves around a few weeks.
Creation of a payer list
The second step involves the development of a list of payers and insurance networks with whom you want to get contracted or participate in their insurance plans. The selection of insurance networks is based on the preferences and requirements of healthcare practice. Following are the major programs that work best for each healthcare practice:
Government health plans
This involves the TRICARE, Medicaid, Medicare, Children’s Health Insurance Program (CHIP) and VA Health Care.
Health insurance
- Right Health
- United Healthcare
- Cigna
- Humana
- Anthem
- Kaiser Permanente
- Blue Cross Blue Shield
- Bright Health
- Aetna
- Oscar Health
- Sidecar health
- Lemonade
Development of CAQH profile
CAQH ( Council for Affordable Quality Healthcare) is a database that verifies the information of providers. First, the CAQH profile is created and then maintained. Making the CAQH profile is extremely beneficial as it allows one to apply for credentials at different organizations at once.
State credentialing application
Some credentialing applications are state-specific and collect information regarding education, training, experience and licensure.
Determining the payer’s credentialing requirements
The first step that you should take before initiating your application process is to decide how many payers you want to work with. Moreover, you should also determine the requirements of each payer. By visiting their official website, you can determine all specific requirements. Then you can submit your application accurately. This step can take time of few days to weeks.
Submission of application
After making a list of payers and identifying their requirements, you can submit your application to each payer. It is always recommended to start your process with government insurance as it usually takes more time compared to other programs.
Regular followups
After the application submission, it is approved. The approval process also takes the time of about a few weeks to months. To increase the speed of the process, experts make regular follow-ups with payers. If there are no follow-ups then it can result the delays in processing time.
Which factors can affect the timeline of provider Credentialing?
There are multiple factors affecting credentialing length such as:
Primary source verification
As credentials have to check every single detail of credentials by complete verification from primary sources, therefore this process takes more time. Credentialing experts have to communicate with educational institutes, previous professional organizations licensing boards etc and then they verify the healthcare providers.
Red flags
During the primary source verification, if any red flag or issue is found then experts make efforts to investigate them properly. This in turn also absorbs the precious time.
Documentation issues
If any document is missing or wrong information is present then it can also delay the process. Therefore regular followups are done to prevent this issue.
Number of payers
If the healthcare providers are applying to multiple payers then it will take more time as each payer has individual requirements. Therefore, healthcare providers have to analyze them and make plans accordingly.
Efficiency of payers
The efficiency of payers also affects the period of the credentialing process. If the payer is efficient in the credentialing process then the medical credentialing timeline can be reduced to a great extent.
Application type
The type of application is also linked with the credentialing time. If the credentialing process occurs electronically then the process is more rapid as compared to paper applications.
Response time to requests
In most cases, payers require additional information during the credentialing. If the information is provided on time then it can also speed up the process of credentialing.
Individual or Group Credentialing
The individual credentialing is not slow and takes less time as compared to the group credentialing.
Self-credentialing or Professional credentialing
Healthcare providers can select any type of credentialing including self-credentialing and professional credentialing. Professional credentialing is more efficient and robust as compared to the self credentialing.
Follow up frequency
If the experts are not maintaining regular follow-ups then they can not locate the issues that arise and it ultimately affects the speed of the process.
What are the best ways to reduce the time that it takes to Credential a provider?
With the help of the following ways, you can increase the speed of provider credentialing and provide multiple benefits to your healthcare practice:
Start the process earlier
Do not wait for the time when you think that the provider is ready to take a start. Make efforts to apply as soon as possible. If you do the credentialing on an early basis then you can protect your practice from any errors or issues that can arise in the process of credentialing.
Easier submission of documents
Credentialing software is used so providers can easily submit their applications online. Their information also remains secure, and the credentialing process occurs rapidly without any delay.
Follow a set process
You should create a workflow specifically for your organization. This will surely prevent the errors that can affect the speed of your credentialing process. Credentialing experts always ensure that every step is performed without any delay and that not a single step is overlooked.
Use digital modes to store data
Use digital modes to store and track all documents related to provider and payer information and communication. When you make a call to payers, make sure that you make a record of the call reference number. This will help you to recall if any setback occurs.
Set reminders and notifications
Follow-ups are necessary in the process of credentialing. Therefore, you should set reminders and a certain kind of notification for follow-ups and make any additional changes.
Choose any credentialing service
If you want to expedite the credentialing process, you can also use any credentialing service. This will allow you to experience faster, reliable, and result-oriented credentialing of healthcare providers.
Seek the Professional help for Provider Credentialing
If you are concerned with the safety and better outcomes of your healthcare practice then you should focus on your provider credentialing process. It’s crucial that the healthcare providers pass through all checks and then provide the best quality care. If you are facing difficulty in the credentialing process and looking for a top credentialing service then Medstar Billing Services is your partner for excellence. We provide effective credentialing services in medical, behavioral and dental healthcare practices. By getting our healthcare provider credentialing services, you can stay on top of credentialing and experience the growth and success of your healthcare practice. So don’t look around and schedule the consultation with our credentialing experts and streamline your credentialing process now.