Bringing on new providers should be a time of growth, not a headache. Yet too often, practices face billing delays because credentialing falls through the cracks. Let's talk about how you can avoid this. Here’s a checklist-driven approach to credentialing that sidesteps the usual pitfalls and ensures your revenue cycle doesn't skip a beat.
Start Early — Credentialing Takes Time
Initiate credentialing as soon as a new provider signs their contract. The process can take anywhere from 60 to 120 days, depending on the payer. UnitedHealthcare might wrap things up in under three months, but others, like Medicaid, can stretch longer. Planning ahead is crucial to avoid revenue disruptions.
Gather Complete Provider Information
This is non-negotiable. Without complete data, you'll hit a brick wall. Collect the following from your provider:
Personal and professional information: Full name, SSN, NPI, and CAQH ID
Practice details: Location addresses, phone numbers, and tax ID
Education and training: Degrees, licenses, and certifications
Work history: Employment dates and contact details for each position
Malpractice insurance: Policy details and limits
Missing even one piece can delay the process.
Use the CAQH ProView Portal
The CAQH ProView is a single source for credentialing data used by most commercial payers. Ensure your provider's profile is up-to-date. Double-check that all documents are uploaded — licenses, DEA certificates, and malpractice insurance details. Many payers love to lean on outdated profiles to deny applications.
Submit to All Major Payers Simultaneously
Submit credentialing applications to all major payers your practice works with — Aetna, Anthem, Blue Cross Blue Shield, and Cigna, to name a few. And do it simultaneously. Staggering submissions is a recipe for prolonged billing gaps. Use payer-specific portals or email, depending on the payer's preference.
Track Application Status
Credentialing isn’t a set-and-forget task. Monitor each application's status regularly. Payer portals provide updates, but they're not always reliable. When necessary, call the payer’s credentialing department — be prepared for long hold times. Keeping tabs helps prevent surprises when you start billing.
Address Payer Queries Promptly
Payers will ask questions. They’ll request additional documentation or clarifications. With each day that passes without a response, billing delays mount. Set up a system for quick replies. Whether it’s a shared inbox or a designated staff member, speed matters.
Confirm Credentialing Completion
Before scheduling patients under a new provider, confirm credentialing completion with each payer. This step is often skipped — at your peril. Call the payer and get verbal confirmation. Document these calls (date, time, representative name) to protect against any future disputes.
Prepare for Insurance Credentialing Delays
Despite best efforts, delays happen. Some payers drag their feet longer than others. Have a contingency plan. Consider holding off on scheduling patients for the provider until credentialing is complete, or keep the provider's schedule lighter to accommodate any potential hitches.
Continuous Communication with the Provider
Keep the new provider in the loop. Explain the credentialing process, expected timelines, and potential snags. They'll appreciate the transparency — and you'll have a more realistic ally in handling any delays.
Educate Your Billing Team
Finally, educate your billing staff about credentialing timelines and payer-specific quirks. They're often the ones who first notice billing issues. An informed team can flag potential problems before they escalate, ensuring your revenue cycle stays intact.
Credentialing is a complex, often frustrating process, but with the right approach, it doesn't have to derail your practice. Prepare, communicate, and follow through. By doing so, you keep your operations smooth and your bottom line healthy.
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