CREDENTIALING FAQ

How important is Credentialing Enrollment to my practice?
Credentialing Enrollment is an absolute necessity.  Becoming an enrolled provider means maintaining steady patient referrals and, in turn, allows for steady cash flow which is the backbone of any successful practice.

How long does the process take?
It typically takes 90-120+ days to fully credential a new provider. Some payers only take 30-60 days and others can take 150 days. If you have existing group agreements, the process can be much faster because we do not need to wait for the contract to be loaded.

Can I hold claims and bill once approved?
Some payors allow you to do this (primarily Medicare & Medicaid) but most commercial insurance companies do not allow retroactive billing. You can bill as an out-of-network provider while in credentialing if you need to start before all contracts are fully loaded.

Can I submit under another physician?
This is inappropriate in most situations unless we can justify using a locum tenens modifier. We would make recommendations on a case by case basis.

What are the terms of our agreement?  
Because so much of the cost/time of the provider enrollment and credentialing is spent in the first 3-5 months of the process, we have broken out the cost into monthly payments spread out through the entire year to help with cash flow for the practice.

What happens after the first year?
After the initial year, we may review your account status and recommend a maintenance agreement.

When will you start on my project?
We will start on your project within 1 business day of receiving the submitted proposal and necessary credentialing information.