Clock | How long does Credentialing really take and why? | STATMedCare Payor and Physician Enrollment and CredentialingSTAT Medcare has been in the business for over 14 years now, and what do you think the most common question is that comes up?

“How long does Credentialing really take and why?”

Well for the ones that are in a rush, the answer is 90-120 days. Granted, this is just on average though, there are some payors that can get the job done much faster, and there are some that can take longer depending on speciality. So let’s get into more detail of what is involved in the credentialing process.

Obtaining the Application

For starters, applications can vary vastly in length. The applications go anywhere from 3-300 pages. To make matters worse, there can be cases where a letter of interest is required. It is a process where they run your Tax ID number and NPI against their database to determine if they will allow you into their network. This decision depends upon how many other providers they already have registered that are in the same geographical area and are of the same specialty as you. If you are lucky enough to receive an application, this is where the hard part starts.

Completing the Application

When making sure the application is complete, the applicant must make sure to have proper documentation. This includes: medical certificates, degrees, CMEs, policies and work history in an organized file so you can quickly find it, to answer each question on the application. The application asks standard questions such as, work history with dates, and explanation of any time gaps. There will also be questions regarding your criminal history, malpractice history and civil suit history. You must also provide documentation for ownership of your business, and these questions go on and on. Any false answering to the questions could very well land you in front of the medical board for questioning.

Submitting the Application

Once you submit your application, unfortunately your work is not done at that point. It is your responsibility to continue to follow up with the process. Payors will say that it takes 90-120 days to process the application, but it is recommended to follow-up weekly. That way you can catch any mistake, and not hold up your application.

CAQH

After your application is submitted the payor compares all information received on your application to your CAQH profile. This means if there are any discrepancies it will delay your application.

Licenses

The payor will also check the status of each of your licenses; from your DEA to your medical license and everything in between. This includes checking a database which will show any and all malpractice claims history. They will also send a query to the medical board to ensure your license is current and active and verify that you have no pending disciplinary actions.

Contracting

After waiting for days, you finally the notice that your application was accepted. Now, there is a few simple steps that need to be in place before you go getting patients.

  1. Payor must write you up a contract, and you need to sign and return it.
  2. Wait until you receive notice of your effective date, and notified your contract has been uploaded to their system.

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STAT MedCare Solutions has been around the block for the past 14 years. Our mission is to provide client services on a foundation of integrity and trust. Let us share one of our professional tools with your practice as well, so you can compare it to or add to your current credentialing process:  Here is a free copy of our Provider Enrollment Checklist.
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