Medical Credentialing

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Today, Medical Credentialing is an important part of starting or building a private practice. In fact, even many veteran healthcare providers, who have had successful cash-only practices for decades, are now scrambling to begin or complete the medical credentialing process for their practices (that is, to prevent the loss of patients or clients, they’re working overtime to get on insurance panels).

Getting on insurance panels (that is, becoming “in network” with insurance plans) hasn’t always been as important as it is today. The change has been coming slowly for several decades, but more recently it has happened very quickly as universally-available healthcare has taken root in the United States.

In addition, over only a few short years, the attitudes of patients and clients has changed. They’ve rejected private pay and demand to use their insurance.

In the not so distant past, clients / patients were willing to pay out-of-pocket for services rendered by physicians, chiropractors, mental health providers (counselors), and other therapists and healthcare professionals. In contrast, patients and clients today demand their primary and secondary medical expenses be covered by their insurance plans. Why the change? For one, healthcare premiums have gone up–way up! And you better believe patients want to get something back in exchange for those big monthly premiums they’re paying!

Hence, if you’re a physician, chiropractor, nurse practitioner, counselor, speech pathologist, or any other type of healthcare provider (or group, or agency, or health center) and you don’t want to turn away potential new patients, you need to start accepting your patients’ insurance–and that means getting enrolled in their insurance plans (i.e., getting credentialed).

It’s no secret that the process of insurance credentialing isn’t something healthcare providers look forward to. While medical / insurance credentialing will probably never become your favorite pastime, there are a few things you can remember that will make the process easier.

If you decide to go the D.I.Y route, you can do it, but here’s what to expect.

1) Expect to Devote about 10 Hours for Every Insurance Panel you Wish to Join

Expecting that credentialing is going to involve just 30 minutes of filling out an application will only lead to frustration. The applications are about 30 pages long, highly detailed, and require information in very specific formats. And once an application is complete, you’ve only just begun. Expect 10 hours of focused labor for each company you want to be credentialed with. This time will include retrieving applications, filling out applications (paper and online), organizing necessary documentation, following up with insurance companies by telephone, and more.

2) Expect to Follow up with the Insurance Companies Often

Insurance companies have a way of losing provider applications, or putting them in “limbo”–where they’re not being reviewed properly and the medical credentialing process goes nowhere. The problem with credentialing “limbo” is that if your application is stuck there for more than a few weeks, it might expire and be automatically rejected, leaving the provider (that’s you) with no option but to start again from “step one” (sound harsh? We wish we were kidding or exaggerating–we’re not). Hence, you’ll want to contact each insurance company every time an application (or any documentation) is faxed, emailed, or “snail-mailed” to them. After that, you will want to call every insurance company about every 2 weeks, to check up on the status on your credentialing process.

3) Expect Time on Hold, Phone Tag, and “We’re Sorry, this Mailbox is Full”

The medical credentialing process is not for the faint at heart, it’s not for those who lack resolve, and it’s not for those without patience–lots of it! In the tip above we mentioned how you’ll need to reach out to insurance companies to ensure that your application process is moving along (and not in “limbo”), but sometimes that’s easier said than done.

  • It’s not uncommon to wait 30 minutes on hold, only to have the line disconnect.
  • It’s not uncommon to call your local provider enrollment representative repeatedly, only to wonder if that person really even exists–because you only seem to reach his/her voicemail.
  • And it’s not uncommon to leave a message (if the mailbox isn’t full) and never receive a return call: Or, even more frustrating, receive a return call 14 days later, miss it by 5 minutes, and then not be able to reach the representative when you try and call him/her right back!

You need to laugh a lot, so you don’t cry!

Consider getting medical credentialing help

For many doctors, therapists, and other healthcare professionals, it makes pragmatic sense to find a reputable service to help with the medical credentialing process. Not only does using a credentialing service alleviate the frustration and headache (don’t take our word for it, ask your colleagues and you’ll probably hear some of their own ‘nightmare’ stories), using a reputable service may also save you money, and have better success getting you credentialed efficiently, meaning you can start seeing those patients or clients with insurance sooner, rather than later.

Interested In Medical Credentialing? Give us a call at 1-855-664-5154

We’d love to have a no-pressure conversation with you about medical credentialing.

Medical Credentialing Reviews