Service Spotlight: Credentialing

Donna White

Donna White

By Donna White, Principal Consultant and Owner of Legacy Consulting Services and Legacy Billing Solutions in Montgomery, Alabama.

Credentialing PaperworkWhat exactly is physician credentialing? Essentially it is a payor’s way of ensuring that the provider has met all necessary qualifications to practice and is providing the appropriate level of care to their patients.

While not every payor requires a provider to be credentialed before they begin to see patients, many of the major payors do. This includes Medicare, Medicaid, Blue Cross Blue Shield in most states, United Healthcare, Tricare and more.

If you are a practice administrator that has never had to do credentialing before, it can be a daunting process. And it is not only initial credentialing that must occur, but providers must be re-credentialed on a regular basis. The length between re-credentialing varies per payor.

Legacy has a team of credentialing experts that knows the requirements for each payor and has the ability to follow up regularly and escalate your applications to make every effort credentialing is complete before your provider is ready to begin practicing at your facility.

Working on Credentialing

However, credentialing does take time. Most payors are going to take anywhere between 60 – 120 days to complete the credentialing process. It is imperative that the process start as soon as you are ready to bring a new provider into your practice. Also, the provider’s certifications, degrees, CVs, and other licensing documentation should be made readily available to ensure timely submission of credentialing applications. The longer it takes to get this information, the more the chance that the provider’s effective date will be pushed back; and not all payors will retro the effective date, so you could be left with patients having Out of Network responsibilities.

At the end of the day, it can be more cost effective to outsource this responsibility to ensure it is done correctly and efficiently. If you know of a provider that needs credentialing services, reach out to Legacy and let us help!

What credentialing challenges have you faced in the past?

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