One of the most important things to remember is that there is no one-size-fits-all approach regarding provider credentialing. States have different laws regarding credentialing, and it is essential to know what your state requires before starting the process.
Not Knowing Your State's Regulations
Every state has specific requirements for different types of providers. For example, only 17 states license naturopathic physicians. Discovering specific state laws and requirements could save your practice considerable time and effort.
Gathering Incomplete Documentation
The information in the Council of Affordable Quality Healthcare's (CAQH) database must be accurate, or it will delay the credentialing process. Studies show that 85% of applications have some information error, such as outdated, missing, or inaccurate information.
Be attentive when collecting information, the first time. Credentialing can take 60 to 180 days, and you can avoid unnecessary delays caused by submitting inaccurate information. Our Credentialing team recommends using a checklist of documents the insurance carriers require for each type of provider, which ensures that you have everything needed for initial credentialing requests.
Every provider tasked with patient healthcare in practice must undergo the lengthy credentialing process and submit educational qualifications, employment history, training, certificates, residency, and licenses. Again, it becomes vital to know your state requirements, as the documentation required differs from state to state.
Incorrectly Submitting Your Applications
It is required that an application initially be submitted to the insurance company you wish to participate with. This step usually entails various verifications to filter out any providers that wouldn't qualify for credentialing. The focus is on disciplinary actions, malpractice cases, criminal records & board certification.
Completing carrier applications and submitting them to the appropriate party can take anywhere from 1-2 hours per carrier. For someone inexperienced, this initial step would likely take much longer.
After jumping through all the hoops, crossing all the t's, and dotting all the i's, something trivial could still cause a delay. This brings us to our next pitfall…
Forgetting to Follow-Up on Your Application
You might think that you are waiting for the green light of approval, but in the world of credentialing, you need to be cautious throughout the process.
It is vital that you do a follow-up immediately after submitting your application. This ensures that the application is in progress and that everything is present. There have been many instances where insurance companies failed to inform the individual about errors in the application, which delayed the already-lengthy process.
It's important to continuously follow up on applications and progress until you receive each approval.
Not Knowing Your Timelines and Failing to Prepare Accordingly
Credentialing from insurers has been reported to take as long as six months. Many insurance companies require credentialing before payor contracts and payments are allowed. Knowing the exact details regarding the issuing of the effective dates of the insurance companies goes a long way when it comes to planning future cashflows.
The Best Way to Avoid These Pitfalls? Practicefirst.
Consider having an experienced team complete your credentialing process on your behalf. You could save hours of time & frustration and ultimately impact your practices' cash flow positively by receiving carrier approvals in a timely manner, with much less demand on your attention.
