THE CREDENTIALING PROCESS

In order to create a tailored plan for your credentialing needs we first discuss where you're at now. We'll ask that you share any issues you may have and your end goal for your clinic. Once we've gathered an overall idea of where you're at and where you want to go, we devise a plan to achieve your goals. Once that plan is approved we can get started on the next step. 

We gather the basic information for the clinic and provider(s) that need credentialing. Credentialing applications typically require a significant amount of documentation, such as proof of education, licensure information, and work experience verification. We also have a specific list of information that each insurance company typically requests. Gathering the bulk of the information upfront minimizes delays in the process. This part of the process relies on our clients providing the requested information in a timely manner so that the credentialing can get started. 

Once we have the information needed, we fill out the applications required for your specific needs. Most applications can be submitted without signatures or approval from the client and/or provider. Those that do require signatures or approval will be sent to the client for signatures. Credentialing requirements can change frequently, and it can be difficult for clients to stay up-to-date on all of the latest changes. We can help clients ensure that they are always meeting the latest credentialing requirements.

After the application has been submitted, we check in with the insurance companies to ensure everything is processing as it should. It can take several weeks or even months for the payer to process it. We follow up with payers on our client's behalf to ensure that the applications are being processed and to resolve any issues that may arise.

Once the application has gone through the whole credentialing process, we will receive a letter of determination from the insurance company. This will be either an approval in which we will make sure you know how to proceed in setting up to bill. Or it will be a letter informing you that the panel is closed. In that event, we can advise you on the next steps according to what would fit your practice best.