The most often asked question we get is “How long will it take to get me credentialed?” The real answer is there’s no way to know. We do go by a standard set of guidelines which tells us it can take 90-120 days. However, there are some payors that are much quicker and some payors (depending on your specialty) that will take longer. We’ll take a look below at what really happens during the credentialing process. Knowing these things will help you understand why medical credentialing can be a long and drawn out process and why credentialing is best performed by experts in medical & physician credentialing services.
Obtaining the Application
Submitting an application for payor enrollment can be an intimidating task. Often, depending on your specialty, it can be hard to even know which application is the proper application to fill out. Once you receive the application it can be anywhere from 3 –300 pages. Some applications are sometimes even longer than that. Often, just to receive an application you must submit a letter of interest to the plan. Once they receive your letter of interest, 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
Completing an application requires that you have all of your medical certificates, degrees, CMEs, policies and work history in an organized file so you can quickly gather the answer to each question on the application. The application will ask you for things such as every place you’ve ever worked and the dates, an explanation for any gaps in work history, copies of all medical licenses you hold as well as diplomas and certificates. This is just the tip of the iceberg. The application will ask a series of questions regarding your criminal history, malpractice history and civil suit history. It will then ask for ownership information about your company. These questions go on and on. Any false answer to these questions could very well land you in front of the medical board.
Submitting the Application
Once you submit the application, and submit all documents that were requested, you will need to diligently follow up. Even though a payor will tell you that it will take 90-120 days to process your application, you should still follow up weekly. That way if something is missing from the application or the payor needs clarification you can provide it to them immediately. Sitting and waiting is the worst thing you can do after submitting an application. Be proactive and stay on top of the process.
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.
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.
Hooray! You’ve received notification that your medical credentialing has been completed. STOP RIGHT THERE! Do not start seeing patients or submitting claims just yet. After physician credentialing comes contracting. This means that the payor must write up a contract and have you sign it and they must also assign you a fee schedule. Once the
contract is signed it then must be uploaded to their claims adjudication software. Sometimes this can take a few weeks. Never begin seeing patients or submitting claims until you have received notice of your effective date, have an executed contract and have been notified that your contract has been uploaded to their system.
Medical Credentialing and contracting can be a scary world. It can consume more time that you ever thought it would. Errors can cause delays and some errors will negate your entire application. Your revenue depends on quality credentialing and contracting. The best advice is to leave these sensitive items to professionals providing medical credentialing services.
Cynthia Young, the former CEO of STAT, which is a national billing, credentialing and practice management consultant. STAT is a U.S.-based, national provider of credentialing, payor enrollment, rate negotiation, and other credentialing related services.