What is Credentialing?
Credentialing is a complex process in which providers submit their qualifications, education, training and experience in order to bill an insurance company for reimbursement. Other terms used interchangeably with credentialing are provider enrollment and contracting.
What does the credentialing process involve?
Becoming credentialed involves obtaining, filling out, and submitting a series of applications with insurance companies. Once your applications have been submitted, you must confirm it has been received and follow up frequently to ensure the process is progressing. Although it might sound fairly straightforward, the process is rarely uncomplicated.
Many providers find their enrollment applications rejected or denied for various reasons. Failing to complete a section or submit a document can cost many lost hours and ongoing effort to resubmit applications.
The credentialing process must be repeated for each and every insurance company you wish to submit claims. On average, a provider can expect the credentialing process to take 90 to 120 days. Most providers would describe the process as burdensome, as it draws time away from patient care and puts strain on office administrators.
Consider the use of a credentialing service to alleviate the stress that credentialing puts on providers and office staff!
For some practices, it’s a no-brainer to hire a credentialing service to handle all credentialing needs start to finish. A dedicated credentialing team can focus their energy on submitting, following-up and ensuring all credentialing is accurate and up to date, allowing you to focus on the patient!
A reputable credentialing service will:
Get your practice and providers set up on the Center for Affordable Quality Healthcare (CAQH).
Ensure all CAQH information is up to date at all times. Including but not limited to: education, work history, reattestations, license expirations, and liability insurance. This prevents insurance companies from denying your application due to outdated information.
Save you days of backlog when multiple re-credentialing applications are due simultaneously
Ensure all credentialing applications and documents are accurate and current, therefore decreasing wait times and increasing revenue!
Handle all communication and follow-up. An excellent credentialing service will confirm receipt of all applications and documents and follow-up at least every 2 weeks to ensure the process is progressing. Frequent follow-up prevents an application being stuck in limbo for weeks.
Give you peace of mind that all your credentialing needs are met in a timely and organized fashion.
Don’t spend another minute confused on credentialing (it could be costing you not just time but money!) Contact Lincoln Reimbursement Solutions today to schedule a time to chat with our knowledgeable credentialing team.