Self Credentialing for Small Practices
Credentialing is the process of enrolling your practice with insurance companies. Any claim will be successful only when your credentialing has been completed appropriately. Each state where you want to practice will require separate credentialing. When it comes to self-credentialing for small practices, you must learn how to navigate insurance credentialing. It is essential, as it affects the patients’ decisions to choose your practice. Many patients will prefer choosing practitioners whose services are covered by their insurance. Insurance credentialing is a time-consuming process. If you want to handle self-credentialing, there are many things for you to know about. Here are four essential things that matter the most.
1. Learn about the State’s Regulations
It is essential to learn about the state’s specific requirements. Some states allow you to bill for services provided while the credentialing process is in progress. Some states will not allow this.
Some states hold reciprocity agreements with certain payors. If your practice is already credentialed with such a payor in one form, your credentialing in another may be fast-tracked by that payor.
When it comes to self-credentialing for small practices, it is essential to keep up-to-date with any changes in laws at both state and federal levels. This can not only help avoid any difficulties due to changes in regulations, but it can also prevent you from missing out on any benefits.
2. Learn about the Timelines
Credentialing approval can take time. Most insurance companies can process The documentation for two to four months. It is essential that your credentialing is complete before your completed services become billable. Keep the following points in mind:
- When entering a network for the first time, it may be possible to start credentialing the documentation before fully processing the contract. This can help reduce the wait time.
- Find out how each insurance company assigns the dates. Some of them can set the effective date from the day of submission of the documentation.
- Consider a single case agreement to fill the gap while waiting for the approval of in-network status.
- Get new hires to submit credentialing paperwork the moment an offer of employment has been accepted.
Gather all the relevant information before you get started. The proper knowledge can prevent delays. Typically, delays in application processing are caused due to incomplete, outdated, or missing data. A lack of complete information can cause the companies to pause the process.
3. Learn about Credentialing for Small Practices Documentation
All insurance companies have unique requirements for credentialing. For example, some will require you to submit proof of CPR training, while others may require proof of RBT certification. A background check is necessary in all cases.
It is best to cover all these requirements during the hiring process. Some of the commonly required documentation for credentialing applications are as follows:
- CAQH: Problems with CAQH numbers are the most common causes of delays in the process. It is essential to know how to navigate and maintain the CAQH profile. The application process can take two to three hours and require uploading certificates, licenses, and professional liability insurance. Before starting the application process, all this information, education, and work history should be handy.
- NPI: The National Provider Identification (NPI) number application process can take up to 30 minutes to complete.
- First Aid and CPR training
- State Licensure
- Resume covering information on dates of employment, explaining any work history gaps of more than three months, and addresses.
- Copy of certificates or transcripts.
4. Follow-Through
Follow-through is an integral part of credentialing. Once all the information has been submitted, conducting a follow-up on the application is essential. This helps ensure that the application is in process. All insurance companies will not inform the credentialing individual or provider about a pending request or missing paperwork.
Once the application has been submitted, you should not assume it will be automatically processed. Follow-up plays an essential role in getting your application approved. The goal should be to get an effective date for billing. The intimation of the effective date will confirm that the credentialing process has been completed, leading to successful claims.
Credentialing for small practices is an intensive process that requires a lot from you. You will have to gather all the information needed for the procedure. If applying to different states, it will be necessary to learn about the regulations for each one. It is also essential that the license is updated. It is important to follow up, no matter whether the applications have been received. The key is to get an effective date. Once credentialing is complete, contracting is the next step. Once this step is complete, insurance companies can pay claims. Since it can be time-consuming and intensive, it is best to seek professional help. For more information, feel free to contact Neolytix.
Frequently Asked Questions
What is involved in Self Credentialing for Small Practices?
Self credentialing for small practices involves filling out applications with insurance payers and submitting supporting documentation. The payers will verify your practice’s credentials to set you up for payments. There are different process paths for other insurance plans. The process details can vary based on the insurance company and your specialty.
What is NPI in Credentialing?
NPI refers to a 10-digit number that you must apply for to be able to bill insurance payers. Type I NPI is for individual healthcare providers and Type II NPI is for organizations and is also called Practice NPI. The NPI and your details attached to it will become your identifying factors with an insurance company. When applying for an NPI, you must submit accurate information related to your name, address, specialty, and type of group.
Which Insurance Payers Should My Practice Credential With?
An office manager or colleague in your area can provide information on the insurance payers with your region’s most extensive patient base. If you are unable to find the desired information, it is recommended to contact us at Neolytix. Besides the significant national plans, consider the several Medicare Advantage and managed Medicaid plans.
If you have more questions about self-credentialing for small practices, please get in touch with Neolytix via the form below.
Get a No Obligation Quote for Medical Credentialing
Medical Credentialing Quote (Active)
"*" indicates required fields
