Insurance credentialing also referred to as Provider Enrollment refers to the process of applying to health insurance networks for inclusion in their provider panels.
The application process involves several steps including completion of a unique credentialing application, the creation and use of CAQH, or acceptance of a state standardized credentialing application. Once your application is received by the insurance company, they perform a thorough credential verification of the provider to ensure he/she meets their credentialing requirements. When all credentials have been verified, the credentialing file goes to the Credentialing Committee for approval. Insurances can take up to 90 days to complete this process and sometimes longer.
Once approved by the Credentialing Committee, the second phase of the process begin: Contracting. Completing a credentialing application does not always guarantee approval to participate in networks.
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Q: How long does the credentialing process take?
A: Each payor varies on processing times, however, it general takes 90 business days for completion and sometimes longer.
Q: What if I don't have the required information?
A: Our credentialing specialist will work with you to ensure you have the proper documentation before applications are submitted.
Q: Is there an application fee?
A: Each insurance has a unique application process which may require an application fee. The application fee is your responsibility to pay during the submission process. Our team will coordinate with you to get this completed.
Q: What if my credentialing application is not approved?
A: As your credentialing specialists, our job is to complete your applications accurately and timely. Unfortunately, this does not guarantee an approval. It is the final determination of the insurance company on whether they decide to move forward with contracting as is determined by your specialty and need for your location.