Streamlining the physician credentialing process can be quite a daunting challenge, considering the paperwork one has to handle while doing this. This is the process, where the insurance company verifies the credibility of information submitted by the physicians. According to experts, close to 800% of physician credentialing applications don’t have the correct and complete information. As a result, this process gets delayed, and the physician faces massive financial losses.
If you are about to apply for your credentialing approval, this article will help you to a great extent, as we talk about how this process can be streamlined to avoid delays, in this article. Submitting many copies of paperwork and waiting endlessly for approval can be quite tough, indeed! However, when you follow this streamlined process, you will find that you don’t have to face too many hassles.
Starting to apply earlier than usual
As a physician, you wouldn’t want to wait for months together to get your credentialing, would you? A great idea to avoid unnecessary delays in this process is to start the physician credentialing process 30 to 60 days before the actual start date. This way, by the time you get your credentialing (usually within about 90 to 120 days from the date of application), you can start getting reimbursements from the insurance provider for patients included in the insurance contract.
You should have a checklist enlisted with the complete list of documents you need to submit to ensure that your credentialing process goes smoothly. These include copies of your qualification, residency program, work history, NPI (national provider identification) number, address and contact number, reports of previous malpractice (if any) and the like. You should check with the healthcare provider about all the information, and submit the relevant documents early to get quick reimbursements.
Getting approval from an insurance company
Before you get your provider credentialing approval, you need to be accepted by an insurance company. So, you can tie up with any insurance company of your choice by submitting all required documents. If you get rejected here, you can save time by not applying for your provider credentialing, as you will definitely be rejected eventually. Getting approval from an insurance company, and then updating all the details on the CAQH (Council for Affordable Healthcare) portal of that company is very important, for your credentialing application to move forward.
Reviewing the credibility of the physician
Once you (the physician) have submitted all your details on the CAQH and insurance company’s portals, it is first verified by a primary source (issuer of insurance), and then by the CVO (Credentials Verification Organization). These checks are conducted to check the authenticity of information submitted by you, and rule out discrepancies, if any.
Moving towards contracting
Once the authorized organizations are satisfied with your work history, and the authenticity of the documents submitted by you, the CVO will set up a meeting with you to discuss the reimbursement terms & conditions. If you agree to these terms, the credentials organization will include you in the healthcare provider network. You will be given a unique number, and an effective date to start receiving the reimbursements. This completes your entire physician credentialing thorough and detailed process.