Frequently Asked Questions

A:Healthcare provider credentialing is the process of verifying and evaluating the qualifications, training, licensure, and professional background of healthcare providers. This process ensures that providers meet specific standards required by insurance companies, hospitals, and healthcare organizations to deliver quality care to patients.

A:Credentialing is essential because it allows you to bill insurance companies for your services, increases patient trust by demonstrating your qualifications, ensures compliance with regulatory requirements, protects you from liability issues, and expands your patient base by accepting various insurance plans.

A:The credentialing process typically takes 60-120 days, depending on the payer and the completeness of your application. Some insurers process applications faster, while others may take longer. Working with TheCredentialing can help expedite the process by ensuring all documentation is complete and accurate from the start.

A:Common documents include: valid medical license, DEA certificate (if applicable), board certifications, malpractice insurance certificate, CV or resume, completed CAQH profile, National Provider Identifier (NPI), professional references, work history for the past 5-7 years, and education/training certificates. TheCredentialing will guide you through the specific requirements for each payer.

A:We offer comprehensive credentialing services including: initial provider enrollment with insurance companies, re-credentialing and maintenance, CAQH profile creation and management, EFT enrollment setup, payer contract negotiations, compliance monitoring, provider directory updates, and ongoing support for all credentialing-related matters.

A:Our pricing varies based on the specific services you need, the number of payers you want to enroll with, and whether you need one-time or ongoing support. We offer transparent pricing with no hidden fees. Contact us for a customized quote based on your practice's specific needs.

A:Yes, we offer comprehensive maintenance packages that include monitoring credential expiration dates, managing re-credentialing cycles, updating provider information across all payers, tracking compliance requirements, and providing regular status reports. This ensures your practice remains in good standing with all insurance networks.

A:Absolutely! We can manage credentialing applications with multiple insurance companies simultaneously. This is actually one of our specialties – coordinating parallel applications to get you enrolled with all your desired payers as efficiently as possible.

A:CAQH (Council for Affordable Quality Healthcare) is a universal credentialing database used by most insurance companies to verify provider credentials. Having a complete and up-to-date CAQH profile is essential because it serves as the primary source of your professional information for most payers, streamlining the credentialing process.

A:Your CAQH profile must be re-attested (updated and verified) every 120 days to remain active. TheCredentialing can manage your CAQH profile for you, ensuring it stays current with the latest information about your credentials, licenses, and practice details, saving you time and preventing enrollment delays.

A:Credentialing is the verification of your qualifications and credentials, while provider enrollment is the actual process of joining an insurance network to become an in-network provider. Credentialing is often a prerequisite for enrollment. TheCredentialing handles both processes seamlessly.

A:Yes, we assist with Medicare and Medicaid enrollment, including PECOS registration for Medicare, state-specific Medicaid applications, managed care organization (MCO) enrollment, and ongoing compliance with CMS requirements. These government programs have specific requirements that we're experienced in navigating.

A:Credentialing involves multiple verification steps including primary source verification of education and training, license verification with state boards, malpractice claims history review, work history verification, board certification confirmation, and background checks. Each payer has their own processing timeline and requirements, which can extend the overall timeline.

A:While we can't control payer processing times, we can significantly reduce delays by ensuring your application is complete and error-free from submission, proactively following up with payers, quickly responding to any requests for additional information, and utilizing our established relationships with payer credentialing departments.

A:If your application is delayed, we immediately investigate the cause, contact the payer's credentialing department, provide any missing information promptly, keep you informed with regular updates, and escalate issues when necessary. Our goal is to resolve delays as quickly as possible.

A:Yes, TheCredentialing provides regular status updates throughout the process. You'll receive notifications when applications are submitted, when payers request additional information, when credentialing is approved, and when your effective date is confirmed. We maintain transparent communication at every step.

A:EFT (Electronic Funds Transfer) enrollment allows insurance companies to deposit reimbursements directly into your bank account instead of sending paper checks. This results in faster payment processing, reduced risk of lost checks, lower administrative costs, and improved cash flow for your practice.

A:TheCredentialing can handle your EFT enrollment by completing and submitting EFT enrollment forms, providing necessary banking documentation, coordinating with payer payment departments, and verifying successful enrollment. Each payer has different forms and requirements, which we manage for you.

A:While not always required, EFT enrollment is highly recommended for efficiency and faster payment processing. Some payers are moving toward mandatory EFT, and many offer incentives for electronic payment enrollment. We recommend enrolling in EFT with all payers you work with.

A:Yes, you can update your EFT information if you change banks or account details. TheCredentialing can submit updated forms to all relevant payers and ensure the changes are processed correctly, preventing payment disruptions during the transition.

A:When credentials are about to expire, we proactively notify you in advance, assist with renewal applications, update all payer profiles with new information, and ensure continuous enrollment status. Letting credentials lapse can result in enrollment termination, so timely renewal is critical.

A:Yes, most payers require re-credentialing every 2-3 years. This involves re-verification of your credentials, updated background checks, current malpractice insurance confirmation, and review of any quality or compliance issues. TheCredentialing tracks these cycles and manages re-credentialing proactively.

A:Changing practice locations requires updating your credentialing information with all payers. We can manage this by submitting location change forms, updating your CAQH profile, notifying all enrolled payers, and ensuring your new location is properly added to provider directories.

A:TheCredentialing helps you maintain compliance by monitoring credential expiration dates, tracking continuing education requirements, ensuring timely re-attestation of CAQH profiles, providing compliance alerts and reminders, and keeping you informed of regulatory changes affecting your practice.

A:Getting started is easy: contact us through our website or phone, schedule a consultation to discuss your needs, receive a customized service proposal, provide necessary documentation, and we'll begin the credentialing process. Our team will guide you through each step.

A:Yes, each client is assigned a dedicated credentialing specialist who understands your practice's specific needs. Your specialist will be your primary point of contact, providing personalized service, regular updates, and expert guidance throughout the entire process.

A:We stand out through our personalized attention to each client, deep expertise in healthcare credentialing, proactive communication and updates, established relationships with payers, comprehensive service offerings, commitment to accuracy and compliance, and proven track record of successful enrollments.

A:Yes, if your credentialing application is denied, we can help by reviewing the denial reason, gathering necessary documentation or clarifications, submitting appeals with supporting evidence, communicating with the payer's credentialing committee, and working toward a successful resolution.