• May


  • 1523

How credentialing works and how to get it done to increase medical practice revenue.

Getting accepted into an insurance carrier network takes work, but it can also mean significant increases in revenue for your medical practice. Credentialing is the term for the vetting process medical practices must pass in order to join an insurance carrier’s network. Insurance carriers, facilities and hospitals use this process to decide whether a medical provider meets all necessary standards to join a network, also known as contracting.

Being accepted into a network is vital for many medical practices today due to the increase in healthcare enrollment. If your medical practice isn’t credentialed by a patient’s network, chances are they’ll go somewhere else to save on out-of-pocket costs. Lack of contracting could cost you thousands a year in revenue.

How does credentialing work?

Before you can participate in a particular insurance network, you must pass certain requirements that include:

  • A review of past education
  • Medical licensure
  • Professional liability coverage
  • State and federal registrations and certifications
  • Residency programs must be completed
  • References from colleagues and past professors

This can be a large undertaking for a full-time physician. The average time it takes a person to complete these requirements is three to four months. That includes submitting all paperwork and documentation and following up with insurance departments. Once the process is complete, it can take up to three additional months to contract.

How to speed up credentialing.

Start the process early. Some medical practices begin credentialing as soon as they have a start date for a new physician.

If your in-house staff is already overwhelmed with work, credentialing could take longer than the typical three to four months. You might want to consider using a third-party service. Some examples of credentialing services include Physician Practice Specialists, Apex and eMDs.

How to begin the credentialing process.

There are many software programs and service providers that can help speed up the process. Physicians will need to use CAQH ProView to securely submit credentialing information. It is the most widely used credentialing database. Just remember not to leave any forms blank, because that will result in your form begin rejected.

When you have provided all information, the insurance company will begin the credentialing process.

Credentialing can be a time consuming and stressful process. However, it is critical to the success of your medical practice. Take credentialing seriously and be diligent about completing the process accurately to become contracted and grow your business.