The Complete Credentialing Guide: Avoid Delays & Start Billing Faster

The fact that you are not paid if you are not credentialed is a constant in the area of healthcare revenue cycles. It's that easy. Credentialing is the first step toward billing insurers and getting paid legally and effectively, regardless of whether you're a new provider or growing your network participation.

However, many practices fail to adhere to it, which leads to unneeded stress, claim denials, and delayed payments.

Our goal at Billing Care Solutions is to make credentialing quick, easy, and error-free. Everything you need to know to start billing sooner and prevent expensive delays is broken down in this guide.

Credentialing: what exactly is it?

The process of confirming a healthcare provider's credentials to make sure they satisfy payer and regulatory requirements is known as medical credentialing. Insurers must verify the following before you can submit claims or join insurance panels:

• Education and licenses.
• Certifications from boards.
• References and work history.
• History of malpractice claims.
• CAQH profile and NPI (National Provider Identifier).
• Registration with the DEA.

Credentialing needs to be updated and re-attested on a regular basis, so this is not a one-time task.

Why Does Credentialing Matter So Much?

You must be enrolled and credentialed with each payer separately in order to receive insurance payments.

Errors or delays may lead to:

• Holdups in billing
• Refused claims
• Out-of-network situation
• Revenue and trust are lost.

Effective credentialing enables providers to:

• Increase patient access more quickly
• Avoid reimbursement gaps
• Continue complying to payer networks

How much time does it take to get credentials?

Timeline on average: 90-180 days

Several factors determine this

• Response time of the payer.
• Completeness of the application.
• Credential history of the provider.
• State-specific specifications.

Regretfully, a lot of practices wait to start credentialing until after a provider has begun seeing patients, which results in unbillable visits and financial loss.

1. Compile the necessary paperwork

Gather all required documentation before you start:

• Tax ID and NPI
• Current medical licenses
• State CDS and DEA certifications
• Insurance against malpractice
• Details of education and training
• Certifications from boards
• Work history accompanied by references
• Hospital privileges
• Finished the CAQH profile

2. Deliver to Networks and Payers:

Every payer uses a different application and submission process.

Medicare, Medicaid, Blue Cross Blue Shield, Aetna, Cigna, Humana, and other insurance companies may fall under this category.

3. Evaluation and Validation of Applications:

Every credential that is submitted is examined and validated by the payer.

Delays will result from any mistakes, missing signatures, or out-of-date licenses.

4. Monitoring and Follow-Up:

This is where a lot of practices go wrong. Regular follow-up is essential. For status updates, give the payer a call or send them an email every two to three weeks.

5. Contracting and Enrollment:

The provider is enrolled in the plan and able to start billing as soon as their credentials are accepted. Contracts will outline terms and rates of reimbursement.

Common Credentialing Errors (and How to Avoid Them)

Error # 1: Incomplete or inaccurate forms

• Impact : Application denial
• Solution : Double-check everything before submission

Error # 2: Expired documentation

• Impact : Automatic rejection
• Solution : Keep licenses, insurance, and DEA current

Error # 3: Not maintaining CAQH

• Impact : Credentialing stalls
• Solution : Update every 90 days

Error # 4: No follow-up

• Impact : Lost applications
• Solution : Set regular reminders to contact payers

Error # 5: Late start

• Impact : Unbillable claims
• Solution : Begin credentialing at least 3 months before seeing patients

How Billing Care Solutions assists in Quicker Credentialing?

By hiring experts like Billing Care Solutions to handle your credentialing, you can:

• Applications that are accurate and comprehensive.
• Payer-specific expertise.
• Frequent status updates and follow-up.
• Quicker turnaround.
• Support and renewals for long-term credentialing.

We serve as your credentialing department, allowing your administrative team to remain stress-free and your providers to concentrate on providing care.

Obtain credentials. Earn money. Remain in compliance.

Complete payer enrollment and credentialing services are provided by Billing Care Solutions for:

• Doctors
• Nurse Practitioners
• Medical Assistants
• Practices in groups
• Behavioral health practitioners
• DME and specialized suppliers

To arrange a free credentialing consultation, get in touch right now. We'll assist you in creating a quicker, more organized route to payment.

Frequently Asked Questions (FAQs)

Q1: What differentiate enrollment from credentialing?

The process of confirming a provider's credentials is known as credentialing. When a provider is enrolled, it indicates that they are authorized to bill a payer for their services after being accepted into their network.

Q2: Do I have to frequently update my CAQH profile?

Indeed. Every ninety days, the majority of payers demand that your CAQH profile be updated and re-attested. Applications may be rejected due to outdated profiles.

Q3: Before seeing patients, how soon should I begin the credentialing process?

Start at least 90 to 120 days beforehand. Getting started early guarantees prompt reimbursement and avoids billing delays.

Q4: Is it possible for me to bill insurance while I'm awaiting my credentials?

Usually not, unless the payer provides you with a written "retroactive effective date." If not, you run the risk of being rejected and not getting paid.