Insurance Medical Credentialing and Provider Enrollment is a complex, time consuming process which requires an understanding of documentation requirements and regular follow ups with Insurance carriers.
Good News – There is a easier way to get this done!
Frequently Asked Questions about Credentialing
Medical Credentialing is the process of providing your individual and Practice information to Insurance companies. This will allow them to check your NPI credentials and register your practice credentials like Tax ID.
This process is mandatory if you want to be in network with certain Insurance companies and get paid for the services provided to the patients you see who are using that Insurance plan.
It involves filling out applications with the Insurance payer and providing them with a lot of supporting documents so they can verify your credentials and set you up for payments in the system. Different Insurance plans have different processes for credentialing.
A lot depends on how promptly the Insurance company or the payer responds back to the application. There is no set standard that they follow. So it is very difficult for a Credentialing company to guarantee that the application process will be completed in 45, 60 or 120 days. However, there are certain things that help expedite the process.
One – Work with someone who has experience in sending applications so they know what documents will enable a “full information packet” so the payers don’t come back asking for more info which usually delays the process. Obviously, multiple back and forth will substantially increase your time for credentialing.
Two – The team should regularly follow up with the payers so they are acting on it quickly and it doesn’t get deprioritized.
Three – Double check all information you are providing when filing the application. We find this problem frequently that the information we receive is incorrect and it results in application delays.
NPI is a 10 digit number which all healthcare providers need to apply for before they can start billing Insurance companies. There are 2 types of NPI’s:
When you credential with an Insurance company your NPI and the parameters attached with NPI like Name/ Address and taxonomy become the basic identifying parameters. It is very important to provide the correct name and address and type of group and speciality etc. when applying for any NPI number Individual or group.
The usual question we get from providers is can I have a group even if I am a single provider? And what is the benefit of having a Group and group NPI?
Yes – you can have a Group with a single provider and bill under Group or Type II NPI that becomes your Billing NPI. In that situation, your individual or Type I NPI is only used as a rendering provider. The benefit to structure your billing like this, will be ease of adding more providers to your group and getting paid under the practice Tax ID or have interns or students provide services and bill as supervisor under the group NPI.
Our Medical Credentialing service experts work with Payers nationwide and are able to provide fast results.
Our Medical Credentialing expert will get in touch with you to scope out the payers, collect all data & background information from you to file medical credentialing with the payers.
We use a combination of electronic submission (where possible) and paper applications for submission. All submissions are tracked and managed using a Workflow management system.
Many Payers have a standard response time however may require clarifications or follow up to make sure the process is completed in a timely manner. Our team makes sure we stay on top of the process.
Medical credentialing is like motor oil. It makes your practice run smoothly. When done right, you don’t even notice that it’s there.
Bad medical credentialing, on the other hand, can have serious consequences. Something as innocent as incomplete paperwork or a single missed deadline can result in revenue loss, denied claims, unexpected retroactive bills, or providers suddenly getting dropped from your practice.
Worse still, incorrect credentialing could allow an unqualified or incompetent practitioner (perhaps even with an expired license) to gain access to your practice.
We double and triple check our records. We gather copies of providers’ licenses, degrees, and peer-reviewed articles and verify each one. We keep a thorough checklist of documents and deadlines. We do all this so you don’t have to.
You are the expert in your field. You spent years in medical school learning how to properly care for patients. But the more time you spend on credentialing tasks that are unrelated to your training and expertise, the more your valuable skills go unused. This is, as Spock would say, highly illogical. Let us handle the paperwork.
Expanding your list of approved plans and payers payers is one of the best ways to grow your patient base. However, since credentialing can take anywhere from 90 to 150 days once the payer receives the documentation, staying on top of this process is key. We will help you identify insurers and add them to your network in a timely manner.
Different practices have all kinds of different credentialing requirements. If you acquire new providers, or if you complete a merger and need to incorporate multiple providers from different practices, We’ll check the requirements.
Providers must be re-credentialed every few years. Neolytix will keep track of all re-credentialing timelines to avoid any unexpected gaps in provider service. We will help your practice thrive in the long term.
Good credentialing is essential to a successful medical career. Bad credentialing will wreck your practice in short order. Don’t let this happen to you. Hire an expert now and save yourself (and your patients!) a ton of grief down the road.
Even in this modern digital age, many medical organizations continue to use slow, inefficient, paper-based methods of credentialing. And when dealing with thousands (and we do mean thousands) of pages of documentation, errors are bound to slip through the cracks.
This is why we at Neolytix are strong believers in electronic medical credentialing. Our experts employ the latest digital credentialing methods to speed up the process, make it more cost efficient, reduce fraud, and minimize the risk of human error. We utilize robust software solutions to combine data collection, verification, reporting, and submission into one integrated process.
Where old-fashioned analog credentialing can only be performed at pre-set intervals, digital credentialing allows for continuous monitoring. This means that, rather than ticking a few boxes every few years, digital records on providers and payers are automatically revised as soon as new information becomes available. Employee records are always up to date, costs will be reduced, and the whole credentialing process is streamlined considerably.
We are, of course, more than happy to handle your paperwork as well. But Neolytix encourages all practices to make the switch to electronic credentialing sooner rather than later. The benefits will become obvious immediately.
Remember, medical credentialing is about one thing above all else: trust. You must be able to trust your providers and payers. Your patients must be able to trust you. Behind all the paperwork and legal jargon are real people who depend on the service your practice provides.