Credentialing is the important process of procuring, verifying, and reviewing a practitioner’s qualifications and ability to provide care or services through a health care organization. Credentials include evidence of education, training, certificates, licensure, and more.
Any medical provider that wishes to be ‘in-network’ with an insurance plans will need to be credentialed. Credentialing is necessary when starting at a new practice (particularly in a new state), after switching or adding locations, or when becoming a provider with an existing practice. Providers will also need to regularly recredential to keep with standards set by organizations such as The Joint Commission (TJC), the National Committee for Quality Assurance (NCQA), and The Centers for Medicare and Medicaid Services (CMS).
Credentialing is a required step of enrolling with commercial insurance carriers, Medicare, Medicaid and DMERC. A provider who is not credentialed properly will find their patients limited and their practice growth stalled. With a credentialed provider, patients can take advantage of in-network benefits which means a larger patient base for your practice. It’s important that this process be done correctly.
Medical credentialing requires a high attention to detail. Applications are arduous and even a small omission or error can mean denial or delay. Providers are responsible for supplying all necessary information. Incomplete or inaccurate reports can mean delays. The credentialing company is responsible for organizing and storing your information as well as filing complete and correct applications with payers, so your applications are approved the first time.
Each payer reviews enrollment applications on their own time, anywhere from 45 to 180 days (depending on the state and carrier being credentialed). The only way to speed up the process is to respond to your credentialing team quickly to get the process started. Only once your credentialing specialist has all of your information and documents can they start the application process. We’ll work closely with you to complete this step in a timely manner.
The credentialing process is complicated, time-consuming, and not something a medical provider should be burdened with. With companies such as PCS available, there’s no need to complete your own credentialing. Leaving this process to an experienced team is highly recommended.
PCS utilizes state-of-the-art credentialing technology to maximize the efficiency and success of your credentialing process. We persist until the process is successful!