What You Need to Know About the Credentialing Process

What You Need to Know About the Credentialing Process

Credentialing is more than just another form to fill out; it’s a complex process and is incredibly important in your ability to see patients and bill for your time at your new practice. Credentialing is not something that you complete once and don’t have to worry about ever again. Even as an established physician, you will still need to be recredentialed every 2 to 3 years with facilities and health plans, as well as provide ongoing, and updated information as required to those same entities.

  • Why is credentialing so important? If you are not credentialed, you may not be able to practice. It’s as simple as that. Provider reimbursement for medical services can be delayed and, even, denied. The credentialing process includes obtaining hospital and clinic privileges, as well as successfully enrolling in health plans as a provider.
  • What are the steps in the credentialing process? Credentialing is a multi-step process. You will first need to determine what health plans, dialysis centers, and hospitals you will require credentialing with based on the patient population you will be seeing. Once determined, applications from those various entities will need to be requested according to each individual entity’s process. Each application will require your signature, and all of the requested documentation (this includes but is not limited to, copies of degrees, board certificates, licensure(s), liability insurance, DEA, etc.). Each entity will complete verification of the various items in your application (such as education, licensure, and work history), as well as conduct a query to see if you have had any disciplinary actions or liability case involvement in your history. Once all of these items are complete, your file is presented to each entity’s credentialing committee(s) (keep in mind, some have multiple) to determine your final approval status. If approved, you are then granted privileges, or in the case of a health plan, you are approved and then moved into the contracting and loading steps. As you can see, credentialing can be a lengthy process. Following up with each entity for status of your credentialing is important in order to know where you are in the process.
  • How long does it take? It depends. Typically, credentialing can take between 90 to 120 days; however, in other instances, it may take up to 180 days. Given this timeline, as a new physician it is crucial to start the credentialing process as early as possible so that by the time you are ready to start practicing, you have much of the credentialing process already completed. If your credentialing isn’t processed by your start date, you will be costing your practice valuable time and money.

Given its many steps, provider credentialing is business critical for your practice. Make sure you talk to the practice manager at your new practice to determine their process for credentialing. Some practices do this in house, while others outsource it since it is such a time consuming and crucial process. Either way, it is a good idea to get a head start on this process to ensure that on your first day you will be able to hit the ground running.

If you have any questions about the credentialing process please email practicesolutions@davita.com to speak to a credentialing expert.

2019-12-01T13:19:58-07:00 December 9th, 2016|6-9 Months before Graduation|0 Comments

Leave A Comment