The Do’s & Don’ts of Medical Credentialing

THE DO'S & DON'TS OF MEDICAL CREDENTIALING DO'S START EARLY An early start is key in getting your credentialing squared away in the average three - to - six - month timeline . Delays often happen at the beginning of the year and again in August . Since processes differ at the company level , it's common for certain insurance companies to take longer than the norm . Furthermore , state - level differences can extend things out longer than you might like . MAINTAIN ALL DOCUMENTS Maintaining all your documents is necessary through the initial credentialing phase and beyond . To start , you need to create a profile in the Council for Affordable Quality Healthcare , or CAQH , system . Then , you must update it on a 90 - to 120 - day schedule to keep the database up to date Beyond that , you must complete your DEA , license , and malpractice insurance renewals on time . Plus , update your CV with your new practice info . KNOW THE REGULATIONS Every insurance carrier and the state has its own regulations . So , be sure to pay close attention to all their rules or risk getting penalized . Your claims could get denied or delayed if you don't . Or you might even end up losing your status as an in - network provider . EXPECT EXTRA FEES The credentialing process often comes with extra fees , especially when it comes to Medicare and Medicaid . The fees can range from $ 100 to over $ 600 , depending on the carrier . So , just be ready to pay the additional amount when you file your application . DON'TS DO NOT ASSUME ALL IS WELL Timely follow - ups are a must while completing payer credentialing . Check - in with the insurance company after submitting documents to ensure it was received . Then , check back every one to two weeks to confirm processing . You may need to provide additional information after submitting the application . Check for mistakes along the way to make sure all is well . AVOID WAITING UNTIL THE LAST MINUTE Every step in the credentialing process takes time , so don't wait until the last minute to complete key steps . Update your CAQH data regularly and don't miss an attestation deadline . Start license renewals well ahead of time . And just generally allow for long turnaround times every step of the way . DON'T ASSUME YOU'RE IN NETWORK ACROSS THE BOARD Upon completing credentialing with an insurance carrier , do not just assume you are in - network for all their products . Get a list of all the plans under the contract . Then , check to see if you need to apply separately for any of their other products . NEVER FORGET TO REVALIDATE Forgetting to revalidate your credentiali can instantly halt payments coming your way . And it's not quick and easy to get started back up again . If you miss a re - credentialing deadline , you may have to restart the entire process , which could result in a three- to six - month delay . Start the revalidation process about 90 days ( about 3 months ) ahead of time to avoid all that . For more details , you may visit www.prognocis.com