What we offer

FAQ

Q: Why would someone want or need medical credentialing?

Being credentialed with insurance panels means that you are able to see patients who have specific insurance plans and bill those insurance companies directly for the services you render. This can greatly increase the number of patients who can access your services.

Q: Do I get to choose the Insurance panels I want to be on?

Yes. When you sign up for credentialing with us, you get to choose exactly which panels you want, and don’t want, to be credentialed with. Typically most outpatient physician providers credential with 7-8 payors, where as hospital based physicians (in-patient) usually credential with 10-15 payors (pretty much any patient with any insurance that comes to hospital). Physicians working in tristate area (border of 3 states) like in our physician owner practice credential with 25 payors. 

Most behavioural health providers, Therapists (PT, OT, ST, ABA etc) typically select 6-7 panels.

Q: How can I track my Medical credentialing progress?

Our Credentialing Specialist will reach out at regular scheduled intervals to provide personalized updates.  Our credentilaing specialist reach out to the insurance providers every 2 weeks for updates.

Q: What if I don’t know which panels in my area are best for me?

We can help! One of our credentialing specialists will talk with you by phone and can help you to select the panels in your area that will be the best fit for you and your practice.

Q: What are some of the more popular insurance companies?

The popularity of insurance companies varies depending on location. However, some of the most popular and largest insurance companies are Aetna, Cigna, Magellan, Tricare, United Healthcare, Humana, Value Options/Beacon Health Options, Medicare, and many others.

Q: How many hours of work does insurance credentialing take?

The amount of time that it takes to complete the credentialing process varies by license type.  For a standard outpatient practice, the Credentialing Team will put in between 10 and 12 hours of work for each insurance panel.  If an appeal has to be filed, that will add a minimum of 5 additional hours of work to that panel.

Facility-based services, Home Health Care Agencies, and DMEs will all take over 20 hours to complete the credentialing process.

Q: Have you ever credentialed or worked with providers with my license type/specialty?

We have credentialed healthcare providers of more types than we can list: from chiropractors to behavioral health providers to surgeons. If you are eligible to be credentialed, we can get you credentialed!

If you are providing a service that is new and innovative, we also offer research with the insurance companies to see if your specialty is eligible for credentialing. This can save you hours of headaches reaching out to the individual insurance panels.

Q: Am I guaranteed to get on the insurance panels I choose?

If you are fully licensed, we should have no problem identifying plenty of insurance companies and third party payers for you to be credentialed with. In some areas, some panels can be very selective or closed. In these instances, we will talk with you about the likelihood of a successful medical credentialing process. We want you to get the most out of your medical credentialing investment, but we cannot guarantee that insurance panels will accept you.

Q: What if the insurance panel I want to be credentialed with is closed?

Finding out a panel is closed can be frustrating. However, sometimes when panels say they are closed, they are still accepting providers, but on a limited basis. In the case of a panel saying that they are closed, we can and will submit an appeal when possible to the insurance company on your behalf. During an appeal, we will try to connect with the insurance company representative assigned to your area. We will then stress important parts of your qualifications and clinical practice. For instance, perhaps you have a specialty that the insurance company desires, or you are practicing in a neighborhood that is underserved. We do have success with many of our appeals. However, if a company is saying that their panel is closed, it might not be possible to get on the panel at that time.

Q: What is an NPI number?

Your NPI is a National Provider Identifier.  It is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).

The NPI 1 number identifies your license type, license level, and specialty.   Panels require that you have your NPI 1 before you begin the credentialing process.

Q: What is an NPI 1 and NPI 2 and do I need both?

An NPI 1 identifies you as the rendering practitioner, or the one providing the service. It’s like your social security number within the medical community. It follows you for the duration of your career. Regardless of who set up your profile, this identifier is unique to you. You take it with you wherever you work.

An NPI 2 is an organization identifier. It identifies the place you are providing the service. If you work for an agency this would be your employer’s company name and information. If you are in private practice this would be in your business name.

We recommend that anyone whose business has a tax ID acquire an NPI 2. From a credentialing perspective, this allows your contract with insurance panels to be at the organization level for applicable panels. Then your NPI 1 is linked to the NPI 2 for billing purposes. Therefore, your business is paid for your services. This becomes especially important as you grow your business and your team.

Additionally, some insurance panels like Medicaid, Medicare, and BCBS require the NPI 2 in order to credential with them if your business has a tax ID.

Q: When do Credentialing and Recredentialing occur?

Credentialing happens before a provider is considered eligible to participate in an insurance network. Recredentialing is done every 1-3 years after the original effective date of the provider to make sure that all of the information listed with the insurance panel are up to date and accurate.

Q: How do I obtain a CAQH ID number?

Almost all insurance panels will require providers to have or obtain a CAQH ID. If you don’t already have one, we are able to create one for you! Let your specialist know that you’d like to have us complete an application for you and we’d be happy to add it to your project. Otherwise, please visit CAQH ProView to start the process.

Q: What do i need to have before starting credentialing?

You should have the following data before you start the credentialing business.

• Obtain a Tax ID from the IRS under the legal business name.

• Register for a Type 2 National Provider Identifier (NPI) and also Type 1 NPI.

• Register for a bank account under the legal business name.

• Search for a location to open your practice.

• Obtain Malpractice Insurance.

• Speak with our Credentialing Department to start the credentialing and contracting process

Q: What is insurance credentialing?

Physicians and other healthcare practitioners such as a hospital, a counseling office, chiropractor, Dentist, Physical Therapist, Occupational Therapist, an optometrist’s office, Urgent care, Treatment center, Social worker etc, who wish to bill an insurance company as an in-network provider must undergo a process of credentialing.

Once a provider is credentialed with an insurance company, they can bill that company directly. In addition, most insurance panels will also provide “in-network” providers with referrals and preferential reimbursement rates. Many panels split the credentialing process into two parts. There is a credentialing phase and a contracting phase. During the credentialing phase, an insurance panel will perform primary source verification on a provider to make sure that the provider meets the minimum requirements of the panel. In addition, the panels may access the CAQH to assess the providers' education and employment history.

Once the credentialing phase is complete, the provider’s application will be sent to contracting. At this time, the provider and the practice may be offered an “in-network” contract with the panel. If they are offered a contract, it will usually include the fee schedule and CPT codes for which the provider is eligible to bill.

we use the term credentialing to encompass both credentialing and contracting phases of the credentialing process. The credentialing specialists are trained to navigate both credentialing and contracting to ensure providers are properly on the panels.