Many providers, new and/or established, often ask how long the credentialing process takes. The problem in answering this question is that there is not set time frame on how long the credentialing process may take. It just depends on the insurance and their application process.
The medical credentialing process can be a very tedious process and the amount of time it takes to get credentialed can vary. There are many different insurance companies to choose to network with as well as many application processes to go through. This can be a very daunting process for any medical process especially since much of the work that goes into the application process is repetitive. There is no way to give an exact time of how the credentialing process takes, but making sure the correct forms are used and completely filled out the first time is very important. Each time the forms need to be corrected and resubmitted, the clock may start over depending on the insurance.
Many insurance companies are now requiring providers to have a CAQH, which stands for “The Council for Affordable Quality Healthcare”, application on file before the provider can be credentialed and re-credentialed. Although the CAQH application process is long, but the length of it is a one-time process and it is free of charge. This information must only need to be kept up to date. Aetna is one of the insurance companies that uses the CAQH and will not let you credential or re-credential unless there is an application on file or it has been updated.
Medicare credentialing can be more daunting than the insurance credentialing application process. Medicare credentialing is required whether you choose to be a participating or non-participating provider. There are several forms that need to be completed. For a solo provider, the provider needs to fill out forms 855I, the EFT, Electronic Funds Transfer, and form 460. For a group, the forms needed are 855B, 855I’s for each individual provider in the practice, the EFT, and form 460. Medicare has also made it possible for providers to apply online using the PECOS system. PECOS stands for Provider Enrollment Chain and Ownership System. There are instructions and other tips to help with the online application process.
A provider does not have to participate with Medicare there are many options that are available. A provider can be a participating provider, non-participating provider, or opt-out. For a physician to be a participating provider means that they accept Medicare’s allowed amount as payment in full. A non-participating provider makes assignment decisions on a case-by-case basis and can bill patient’s for more than the Medicare allowed amount. The last option is to opt out and become a private contracting physician. This would allow the physician to bill the patient directly, but neither the provider nor the patient can receive any money from Medicare.
Credentialing can be a stressful process. Let Practice Management Solutions take care of this process from beginning to end for you. Contact us at (877)353-8819.