The Credentialing Process: What To Expect

The Credentialing Process
The Credentialing Process

With a lot of variations and complexities involved, Medical Credentialing Process becomes confusing to a lot of Healthcare Practitioners, new and old alike. Specifically for new entrants, Credentialing & Enrollment process can get overwhelming. With the right knowledge, guidance, and expectations, it becomes easier to navigate through Credentialing & Enrollment processes. 

As you read this article, you will gain clarity on the entire process of Credentialing, the challenges involved, and tips to ace it like a hero! 

Before we get to the process, allow us to quickly explain the need of going through the seemingly complex process of Credentialing & Enrollment. 

Need Of Credentialing & Enrollment 

Credentialing is required for all Healthcare Providers, whether in mental health, behavioral health, primary care, urgent care, or others.  

The purpose of Credentialing & Enrollment is to ensure that all Healthcare Providers are appropriately qualified and have the necessary training and experience to provide quality care to patients.

Additionally, Credentialing can improve your cash flow by helping you get paid for the services you provide. 

It helps in expanding the number of patients with additional clients from insurance companies (payor network). 

Overall, it protects your reputation as a quality Healthcare Provider and ensures you are getting paid for the services. Hence, it is mandatory for every Healthcare Practitioner to undergo Credentialing & Enrollment. Let us see how it is done. 


Overview Of Credentialing Process in Healthcare

There are two phases of the entire Credentialing process and lifecycle. First is when you apply for the first time and second is when you re-apply for Credentialing. 

Initial Credentialing – Process Overview 

  1. Gather And Verify Documentation – The first step in applying for Credentialing is gathering all of your documentation. This includes verifying your educational degrees, training certificates, work experience, licenses, and other qualifications. 
  1. Fill And Submit Application – Once you have gathered all of your documentation, you will need to complete an application form. Be sure to carefully read all of the instructions and answer all of the questions accurately. If you are unsure about any part of the application, be sure to contact the organization directly for clarification. 
  1. Application Review – Once you have submitted your Credentialing application, it will be reviewed by a member of the organization’s staff. They will verify that all of your information is correct and up-to-date. If everything looks good, they will send it on to the appropriate licensing body or other organization for approval. 
  1. Primary Source Verification – Once your Credentialing application has been reviewed and accepted, the next step is verification of your qualifications. This may involve contacting various organizations, such as past employers or colleges and universities, to verify that you have the necessary training and experience to practice in the healthcare field. It may also involve completing additional tests or exams, such as the National Exam for Practitioners of Medicine. This exam is required by some organizations in order to be credentialed. 
  1. Approval Or Denial – Once all your qualifications have been verified, you will receive a notification that you are approved or denied for Credentialing status. 
  1. Proceed For Enrollment Or Re-apply – If your Credentialing application is approved, you can now successfully go-ahead for Enrollment with selected payors. If it is denied, you need to re-apply with the required corrections made. This is best done with the assistance of an expert. 

Re-Credentialing – Overview 

Credentialing status needs to be renewed every few years, depending on the organization. It’s important to keep your paperwork and documents up-to-date so that you can continue to practice without interruption. 

The Re-Credentialing process is similar to the initial application process. You will need to review all of your qualifications and submit your application and supporting documentation to the relevant organization for review. 

How Long Does The Entire Medical Credentialing Process Take? 

Typically, it takes 2-4 months for Medical Credentialing Process, if all goes well. If not, it can even take a year. The time it takes to complete the Medical Credentialing process can vary depending on the complexity of your application and how quickly all of your documentation is verified.  

Having said that, it is important to understand the Factors Which Can Cause Delay In Your Credentialing Process and importantly How Can You Expedite Your Credentialing Process? 

We recommend that you read the above articles for more clarity and a deeper understanding of the factors causing delays and tips to expedite your Credentialing process. 

Consider using the services of Credentialing Specialists to ensure that your application gets processed and approved in time, saving you energy as well as money. 

The longer it takes, the higher it costs. Let us quickly understand the cost of Credentialing process in healthcare. 

How Much Does Credentialing Cost ?

The cost of Credentialing in healthcare can vary greatly depending on your particular qualifications, the medical organization you are applying to, and other factors. Generally speaking, Credentialing costs range from $400 – $1500 for an initial application. Re-Credentialing fees usually run between $250 – $500 per renewal. In some cases, Medical Insurance companies may cover part or all of the Credentialing fees, so it’s important to check with your insurance provider first.  

A quick approval can save you time and money. Getting right expert Credentialing assistance can make this seemingly overwhelming process simple and seamless.  

Get In Touch 

Have specific questions regarding any step of the Credentialing & Enrollment process? Want to know more about how you can get it done in a simple and seamless manner? 

With our expert team, powered by Apaana-PULSE (a proprietary technology), your queries do not have to go unanswered and your Credentialing does not have to be complex. 

You can fill out the form below to let us know your requirements or doubts.

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