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The Scary Credentialing Process...Where Do I Start?

Credentialing seems to scare a lot of providers. So much so that they are willing to pay whatever it takes just to let someone else take care of it. Be mindful, while it can be expensive – it doesn’t have to break the bank.

When I did my first providers credentialing, I had no idea what I was doing. I just went to different insurance websites, clicked on “Join our Network” or “Become a Provider” and just started filling in applications. Hours and hours of applications later – I wish I would have hired it out. I learned a lot, but it also ate up a lot of time that I could have been putting towards something else.

Credentialing by yourself is not hard, per se. It IS time-consuming, and let’s face it, time is not something you have a lot of if you are working a full-time job and trying to start your own practice at the same time. It is easier to pay someone just to deal with the headache of the process and the red tape that goes along with it. Anticipate spending at least 10 hrs. of undivided attention to EACH insurance company. This includes the application process and frequent follow-up calls and/or emails.

Be prepared to “hurry up and wait.” On average, it can take 60 to over 120 days to get credentialed with insurance companies. It is a time consuming and frustrating process.

Playing the waiting game can be daunting. With a lot of insurance companies, there is no way to find out where you are in the process. You fill out the application, hope they get it, and process it in a timely fashion. However, glitches do happen…and you may find yourself having to send in a new application a couple of months later. Some of them will only tell you “we have received your application and you are in the process.”

You have to update your CAQH profile and attest it, gather up a bunch of documents, fill out applications, wait…wait some more…wait a little longer…and there is no guarantee they will accept you into their network. Ugh!!

You may think, that since you are already credentialed at your current employer it will be a piece of cake to get credentialed at your new private practice… wrong. Every insurance company is different, every state is different – so the answer is not always the same. Sometimes it's a simple adding of a new tax id, and others want a completely new application. Calling your current insurances companies and speaking to someone in credentialing can usually provide you with this information.

You can even be credentialed at one place and get denied credentialing for your new practice because they are “not accepting new providers for your specialty.” How much sense does that make? You are already “in-network” with the other place. Well, my friend, welcome to the world of credentialing and insurances. Sometimes (well…a lot of the time) nothing makes sense with insurances.

If you want to take this process on yourself, Silver Leaf Practice Management Solutions can walk you through it at an hourly rate, or we can just make it easier on you and do it for you. We do not have a magic wand and can’t promise you that we will get you credentialed with every single insurance company you want, but we will make every effort trying to make it happen while keeping you informed every step of the way.

Things you will need to gather up prior to starting the process:

· Copy of all your licenses (APRN, DEA, RXN)

· EIN/TIN Number

· Office / location address (don’t use your home address if at all possible)

· Resume / CV – Make sure it is current with NO gaps of employment)

· Copy of your malpractice insurance

· Copy of your liability insurance

· Board Certifications

· Completed W-9

Then you have to make the decision to DIY, or hand it over to someone else. We are happy to help you either way – contact us for your free consultation.

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