The duration of Provider Credentialing can vary, typically spanning from a few weeks to several months, depending on a range of factors. This extended timeline is a result of the intricate nature of the process, which encompasses activities such as research, document collection, application submission, ongoing communication with payers, and the waiting period for their application approval. This complexity can be quite intimidating for healthcare providers.
When it comes to Provider Credentialing, you have two primary options. You can either choose to navigate the process independently or opt for the expertise of credentialing professionals, such as Talisman Solutions, who can seamlessly handle the entire process on your behalf.
Before diving into the two credentialing approaches, let’s understand the key factors that impact the process:
1. Provider Complexity: The complexity of the provider’s background, education, and practice history can impact the credentialing process. For example, a provider with a complex background, such as multiple specialties or a history of disciplinary action, may require additional scrutiny.
2. Documentation: The provider’s knowledge of required documentation and its availability can also affect the credentialing process. Providers who are well-organized and have all of the necessary documentation readily available are typically able to complete the credentialing process more quickly.
3. Number of Payers: The number of payers the provider is applying to can also impact the credentialing process. Each payer has its own unique credentialing requirements, so applying to multiple payers can be time-consuming.
4. Payer Efficiency: The efficiency of the payer’s credentialing process can also affect the overall time it takes for a provider to be credentialed. Some payers have more efficient credentialing processes than others.
5. Application Completeness and Accuracy: The completeness and accuracy of the provider’s application and documentation are also critical factors in the credentialing process. Incomplete or inaccurate applications can lead to delays or even denials.
6. Error and Omission Prevention: Providers should take steps to prevent errors and omissions in their credentialing applications. This includes carefully reviewing all documentation and submitting it in a timely manner.
7. Payer Requirements: Providers must adhere to specific payer requirements during the credentialing process. These requirements can vary from payer to payer, so it is important to carefully review the instructions for each payer.
8. Timely Response to Requests: Providers should respond to requests for additional information from payers in a timely manner. This will help to avoid delays in the credentialing process.
9. Application Type: Providers may choose to submit electronic or paper applications. Electronic applications are typically processed faster than paper applications. Some payers only offer paper applications, which complicates the process, and obtaining these paper applications can be a challenge in itself.
10. Frequency of Follow-Ups: Providers should maintain regular follow-ups with payers to keep track of the status of their credentialing applications. This helps ensure that the process is progressing swiftly.
11. Group or Individual Credentialing: Providers may opt for individual or group credentialing based on their current circumstances and future objectives. Individual credentialing generally requires less time compared to group credentialing.
12. Self-Credentialing or Professional Credentialing Company: Providers may choose to self-credential or use a professional credentialing company. Self-credentialing can be more time-consuming and complex. Professional credentialing companies can help to streamline the process.
These are the factors that impact the time the actual credentialing process will take. There are things you can do to speed up the credentialing process, but honestly, managing the process by yourself is a herculean task.
Let me walk you through what both of these options entail.
I. Doing Provider Credentialing By Yourself
Before embarking on the journey, it’s crucial to understand that the Provider Credentialing process can be highly intricate and complex, particularly when applying to multiple payers with demanding and time-consuming credentialing procedures. Suppose you are brave enough and choose to navigate this path independently, then you’ll need to follow a series of steps, and the time required for the credentialing process will depend on how effectively and accurately you execute each of these steps.
1. Gather All The Necessary Information:
During this stage, it’s essential to conduct independent research to identify the crucial documents required for the credentialing process. Once you have a clear understanding of the necessary documents and information, you must diligently gather all pertinent details and records related to you and your organization or clinic. This comprehensive set of information encompasses your physical address, mailing address (if different), clinic fax number, group or individual National Provider Identifier (NPI), Employer Identification Number (EIN) or Tax Identification Number (TIN), educational and professional work history, references, specialty, working hours, malpractice insurance, professional liability insurance, DEA document, medical license, and Master Provider Index (MPI) or Group MPI.
The duration of this step can vary, typically taking a few weeks. The timeline depends on your research and record-organizing skills, as well as the ease of obtaining the necessary information from your former employers, references, and licensing boards.
2. Create a Payer List:
Create a list of the insurances and payers you wish to contract with and participate in their plans. Make your selections thoughtfully, focusing on your top choices.
- Health insurance: UnitedHealthcare, Kaiser Permanente, Anthem, Cigna, Humana, Aetna, Blue Cross Blue Shield, Oscar Health, Clover Health, Bright Health, Sidecar Health, Lemonade
- Government health plans: Medicare, Medicaid, Children’s Health Insurance Program (CHIP), Tricare, VA Health Care
The duration of this step can vary from a few hours to several days or even weeks, depending on the number of payers you wish to work with, the time you have available to prepare the list from your busy schedule, and your familiarity with these payers, health insurance companies, and clarity about your specific needs.
3. Complete Your Caqh Profile And State Credentialing Application:
In this step, you have to create or update your CAQH profile and complete your state’s standard credentialing application if your state requires it.
- CAQH profile: CAQH stands for Council for Affordable Quality Healthcare. A CAQH profile is a standardized online application that many healthcare organizations use to collect information about healthcare providers. Creating a CAQH profile can save you time and effort, as you can use it to apply for credentials at multiple healthcare organizations at once.
- State credentialing application: Some states require healthcare providers to complete a state-specific credentialing application. This application typically collects information about your education, training, licensure, and experience.
This step can take a few days to a week, depending on how complete your CAQH profile is and how complex your state’s credentialing application is.
4. Researching the Payer’s Credentialing Requirements:
Credentialing requirements can vary widely, from straightforward to highly intricate. Each payer may have unique prerequisites, so it’s crucial to research the specific requirements of every payer you intend to work with before initiating the application process. You can typically access this information on the payer’s official website. This step generally takes a few days to a week, depending on the number of payers involved.
The list of health insurance companies and payers you compiled in the second step will be invaluable during this research process. After completing your research, you will have a clear understanding of each payer’s document, information, and application requirements. This knowledge is especially useful when dealing with payers who have more complex processes or need additional documentation. Additionally, it will help you identify whether a payer uses digital or paper applications. This preparation ensures that you efficiently submit your application without the risk of missing documents or important information at the last moment.
This step can vary in duration, ranging from a few days to a few weeks. The time required depends on the number of health insurance and payers on your list and your availability for research. It’s important to note that not all health insurance companies or payers have their information readily available on their websites. In such cases, you may need to contact their customer care service to inquire about their specific requirements, which can be a more time-consuming process.
5. Application Submission:
During this phase, you will submit your applications to each payer in your list. If government insurance is included in your list, it’s recommended to start with them, as their credentialing process often takes longer compared to other payers.
The duration of this step can range from a few hours to a few days to a week, depending on the number of payers you are applying to, your availability, and the complexity of their online application systems.
6. Follow-ups For Faster Approval:
Following the submission of your application, the approval process typically spans several weeks to months. However, it’s important to be aware that this timeline may occasionally extend due to various factors, including the payer’s workload, lack of follow-ups, requests for additional documentation, or even the need for an interview.
To expedite the process, it’s essential to proactively maintain regular follow-ups with payers after you’ve submitted your applications. Although this follow-up procedure can be demanding, it is a crucial step. Failing to follow up may lead to processing delays, potentially affecting the successful outcome of your credentialing.
How Long It Will Take
Depending on your performance in each step, the other factors mentioned earlier, the credentialing process can span from 4 to 6 months at least or potentially even longer if you make a mistake in any step, which unfortunately is very common when providers try to go through the credentialing process themselves.
II. Outsource Provider Credentialing to Talisman Solutions
Skilled Provider Credentialing firms like Talisman Solutions have a deep understanding of the entire Provider Credentialing process. They are familiar with various government and private payers at both state and federal levels. These experts know precisely which documents are needed for each payer’s application, making the credentialing process quick and efficient. They know the common mistakes and pitfalls to avoid. They also leverage technology solutions like AI to accelerate the process. Their knowledge ensures the right actions are taken at the right times, saving you valuable time and money.
If you make the smart choice to outsource your credentialing to expert Provider Credentialing firms like Talisman Solutions, you won’t need to concern yourself with intricate research, diverse requirements, submitting applications to multiple payers, or ongoing follow-ups with each payer post-application submission. When you outsource the credentialing process, there are still a few steps you need to follow, as listed below.
1. Initial Meeting and Needs Assessment:
The Provider Credentialing company will start by meeting with you to comprehend your needs and objectives. They will discuss the payers you wish to collaborate with and any specific requirements. This step typically takes about 2-3 hours to complete.
2. Information Gathering:
Once you’ve provided the company with information about the payers you intend to work with, they will prepare a document outlining all the necessary documents required for your applications. As experts in the field, they won’t need to conduct additional research for this information, as they are already knowledgeable in the specific requirements of each payer. The documents typically pertain to your education, training, licenses, experience, and references. Additionally, they may request details from your previous employers and licensing boards or any other pertinent information based on the selected payer’s criteria.
This step can take up to a few days or a week, depending on how quickly you can provide the requested documents to the company for the credentialing process.
3. Assist The Provider In Setting Up A Caqh Profile (If Needed):
If you don’t already have a CAQH profile, the Provider Credentialing company will help you create one. If your profile isn’t updated, they will assist in the update. If state credentialing is required in the state where you are operating, they can guide you through the process or handle it on your behalf.
Creating a CAQH profile streamlines the credentialing process. Now, they can apply for credentials at multiple healthcare organizations simultaneously on your behalf, saving you a significant amount of time.
When you work with a professional credentialing company like Talisman Solutions, this step is completed swiftly, and your profile will be ready within minutes.
4. Application Submission, Interviews, and Additional Information Requests:
Armed with all the required information, the Provider Credentialing company commences the credentialing process with your chosen payers. This involves reaching out to the payer for the application form, diligently filling out the applications, ensuring information is up-to-date, engaging in interviews, and providing any supplementary details as required by the payer.
Their experienced staff efficiently submits multiple applications simultaneously, a task that might take you days or weeks, but they accomplish it within hours.
They maintain communication with the payers, and if any payer requests additional information or documents, they’ll reach out to you, guide you on providing the required documents, and ensure a smooth process, even assisting with interviews when necessary.
5. Follow-Ups and Issue Resolution During the Credentialing Process:
The Provider Credentialing company maintains consistent communication with the provider throughout the credentialing process, offering regular updates on your application status and assisting in the resolution of any arising issues. They also proactively follow up with the payer to expedite the credentialing process.
In cases where critical information is found to be incorrect, the company promptly contacts you and guides you in collecting the necessary, accurate documents. If a resubmission is required due to a significant issue with the documentation, they ensure that the correct and up-to-date documents that the payer requires are prepared for a new application.
6. Notification and Documentation:
Once you have been successfully credentialed by the payers, the company will notify you and provide any required documentation, including credentialing letters and contracts. The company may also continue to monitor the provider’s credentialing status to ensure it remains up-to-date.
How long it will take
Professional Provider Credentialing companies like Talismans Solutions can efficiently complete the Provider Credentialing process within 90 to 120 days. This is considerably faster and more effective compared to healthcare providers attempting to navigate the process on their own, especially when they lack the necessary insights and experience to address the various challenges that may arise.
Conclusion
Provider Credentialing is a complex process influenced by several factors. Providers have two options: navigating it independently or enlisting the expertise of credentialing professionals like Talisman Solutions. The latter choice streamlines the process, saving valuable time and ensuring efficient outcomes.
By handling each step meticulously, providers can potentially complete credentialing in 4 to 6 months, though it may take longer if errors occur. On the other hand, outsourcing to experts can shorten the process to 90 to 120 days, providing a faster and more effective solution. This decision ultimately depends on your resources, expertise, and priorities.
