Provider Credentialing Q & A

Time: How long does it take to get provider credentialing?

It can take anywhere from 60-120 days, but that is only if you provide all of the information correctly the first time. If there is a petition process, lobbying, or appealing, it can take between 190-220 business days.

After years of experience, the credentialing team we recommend knows the ins and outs of provider credentialing and knows how to work the process.

Certification

If one is not board-certified, are they eligible to be credentialed with insurance companies?

For some yes, for some no. The requirements are always different. For the major companies, Aetna, Blue Cross, United, etc…, it is going to be required for Medical Doctors.

What is the difference between board certified and board eligible?

Board eligible can also be used for board certification. It means that you are eligible to take the board exam, but you haven’t yet. They want you to be board eligible and take your exam while you are being credentialed or shortly after.

This does not apply to Master’s level mental health providers. Board certification for MA level is only beneficial; it is not required, however, it does look good that you have become board certified.

NPIs

What is a NPI number and what is the difference between a NPI 1 and a NPI 2?

NPI (National Provider Identifier) and an NPI 1 is assigned to an individual provider and a NPI 2 is assigned to an organization. For example, Jon Doe LPC will get an NPI 1. Jon Doe LLC will get an NPI 1 and an NPI 2.

How long does it take to get NPI’s numbers?

I could take as little as 5 minutes. It is very easy – simple questions. Although it could take as long as 3 days to a week.

A NPI is not a big deal. Whether you are aiming for a NPI 1 or an NPI 2, the process is not a difficult one.

Missing Information on Applications

A counselor submits an application to an insurance company, and a month later (yes, a month!) the insurance company gets back to him and lets him know that he is missing information. The counselor swears that he had all of the information needed, but what happened? How is that possible?

Insurance companies can lose documents and they can make mistakes. They are not perfect. They could have 10 people working on your application. A human being is working on your application, and they can misplace things.

Keep your work from getting lost in transit. Keep a copy of everything that you submit – whether it be a signature page or a resume, make sure that you keep a copy of everything that you submit.

Also follow up with the insurance company (when you can, always fax or electronically submit something, rather than send in a paper copy). Then, once you have submitted it, make sure you call the insurance company and make sure they received everything that you submitted. Follow up with the insurance company. And keep following up until they’ve confirmed that the process has been completed and you are on the panel.

Getting the application submitted is step 1, making sure that the insurance companies received all of the information is step 2, and continuing to follow up with the insurance companies is step 3.

Can Interns be Credentialed?

I am post Master’s but I do not have my license yet. Can I be credentialed?

Most often no. The major providers will not accept; however, there are some companies that will allow you to bill under your supervisor – Medicare in some states will allow this. But overall, as an intern you cannot be credentialed individually. For example, in Massachusetts, the clinic cannot be a normal private practice; it has to be a Certified Community Medical Health Center.

So for smaller practices, getting interns certified is a no go. They will not be able to get on BCBS, Aetna, or Cigna. For the most part, unless they are working with Medicare, Medicaid, or a state sanctioned company, interns won’t be able to get credentialed until they are licensed.

Let an Experienced Team Do It For You

If you’ve had enough of fighting with insurance companies, and filling out provider applications, just to have those applications lost or rejected, let a credentialing team help. If you’re looking for help with medical billing or credentialing, consider our friends at Credentialing.com. They’re available to offer a timely quote, or help you find a solution. You can reach them at 1-855-664-5154 or filling out this quick and easy form here.