Provider enrollment, also known as payor enrollment, involves applying to health insurance networks to join their provider panels. Once approved as a participating provider, the next phase commences: contracting.

To put it simply, you get to see more patients. If you have enrollments across a larger number of Insurance panels and have the participating status you can see them without high co-pay.

Our per-application pricing depends upon volumes. If they are a larger number of insurances then you get a good discount.

Our per-application cost ranges from $130 to $200 per payor application. Besides this, we have a setup fee or Provider / Group / Facility that allows us to build their profiles with no room for error.

Credentialing happens before a provider is considered eligible to participate in an insurance network. Re-Credentialing 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 is up to date and accurate.

Delegated Credentialing is done when groups are large enough (such as hospitals or universities) the payors can grant an addendum to a contract allowing the group to maintain their own Credentialing. This saves time since the payors can be inundated with applications and get backlogged. With Delegated Credentialing, the group or its contracted company is responsible for completing the primary source verification process typically performed by the insurance company. It’s the responsibility of the delegated entity to ensure that all providers meet the standards as set forth by the insurance company. Once the provider is Credentialed at the facility (such as a hospital) the entity would send each delegated payer a roster (typically once a month) showing all employed Providers and any new additions since the last report.

Almost all private commercial 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 and we’d be happy to add it to your project. Every four months, you will receive a request from CAQH to re-attest that all of the information in your application is correct.

Yes, you get to choose exactly which panels you want, and don’t want, to be credentialed with. If Panels are closed we offer replacement panels at no extra cost.

We can help! An Apaana Specialist can help with some recommendations,  your decision on the panels is final and we will go with that. Our recommendations on panels come from ncqa.org besides other sources.

Many Private commercial insurance panels will take the information from your CAQH profile in order to initiate the process.

If a provider submits an application on the payor website for the respective panel, the application will go through the process and the private commercial payor panel will typically access your CAQH profile to verify the information on your application.