Credentialing

According to Wikipedia, “Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their legitimacy”.

But it’s not just for medical professionals; credentialing also applies to licensed behavioral health clinicians and certain other non-medical workers.

The purpose of establishing legitimacy is for both employment and insurance billing purposes, and came about after some horrendous quackery and hoaxes were perpetrated by people who lied either about their education, training and work experience, or about the quality of that work experience with a previous employer. Tragically, some patients died as a result of unqualified shysters performing surgeries, misdiagnosing disease processes, or prescribing the wrong medications. As you can imagine, there were many lawsuits – and legitimately so – and now, medical facilities and insurance companies don’t want to take any chances.

What We Do:
… work with multiple insurance companies to admit you to preferred provider network status by verifying your credentials (there are some insurers who aren’t taking new providers but we’re working to get that changed),
… if you don’t have one already, we can help you get your Level I (individual) NPI, or your Level II (group),
… we can also help you determine your taxonomy code,
… and we’ll keep you current with attestations and your CAQH account.

Can’t I Do My Own Credentialing?

Absolutely, any licensed professional can do their own credentialing work, and many have, although that’s getting less and less frequent nowadays.

Every insurer has its own system and expectations. Even with a CAQH account, which was intended to streamline the credentialing process, it’s become a challenge to get smoothly through some insurers’ processes.

Even in the past year, there have been major changes and challenges. Several of the largest insurers have increased the complexity of the credentialing process, there are extreme delays (including miscommunications, websites that don’t work properly, lack of responses to emails & phone calls, uncertainty within the insurers’ staffs about the process, etc), and one very large insurer even changed their whole system completely in the midst of us trying to get a client credentialed for in-network billing!

So it can be rather a nightmare to pull it all together, but as we’ve been doing this work in the midst of all the changes, we have a decent handle on the intricacies. A little less hair, perhaps, from pulling it out, and several headaches, but we’re good with it all.

It is important, though, that the clinician be available to respond to questions as quickly as possible, because there can be several starts & stops to the process. Some clinicians are so busy either with their practice or other jobs while they’re building their clientele, that a week or two has gone by before we received a response to a question that, unanswered, has stalled the application. If we then can’t get back to that particular application for a couple of days, it slows the process down considerably… and it’s already lengthy, averaging 2-3 months once the completed application is submitted!

Not sure if you want to go in-network or just take your chances with out of network billing, or perhaps private pay clients only? We’d be happy to sit down and discuss your various options!

Cost of This Service:

Our hourly fee for our Payments & Collections service is $25.00, billed in quarter hour increments, with weekly invoices emailed to you on Sunday evenings.

If you choose to combine this service with basic office supports (see the Practice/Office Management tab), the hourly fee is $22.50, also billed in quarter hour increments.

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