Credentialing: The Only Pain Doctors Can’t Relieve

We all know how hard it is to recruit a physician these days. The specialty is sure a challenge, but an even bigger challenge is finding a compatible physician for the job.

When you are done with the selection process and have signed up a physician for the job, the actual problem starts. That is...

You can't put him to work right now.

Why?

He is not credentialed yet. Or, to put it simply, the insurer hasn't credentialed him yet.

Why did I say it the other way? Because you may have provided all the documents for the credentialing process but until they are verified by the insurer your physician can't start work. He can see the patients if he wants to, for free. But he cannot get paid for it. The insurer will just not pay for the patient's work until the physician is verified. And, how will he get verified? When they confirm his identity, his skills and his credentials.

And until he is not part of the network, he will not get paid for the services delivered to the patients. They will be marked as free services.

The worse thing about the whole credentialing process is that it can go on for months. There isn't a plausible time for the whole credentialing scenario so you can wish your luck to make it faster. Usually, it takes more than six months for the process to complete. And, one can only think what a physician will do during that time.

Certain agencies can fasten the whole process though. Our organization is one of them. We support the legislation (HB 1663) to streamline the physician credentialing process and make it uniform across all insurers.

Plus, we have experts from the field, who have remained on the other side of the credentialing process. They have a vast network that can bypass many hurdles in the way of the process, decreasing the timeframe from six months to around two months.

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The credentialing process isn't free and the process can garner around $3000 from the medical practice. This cost isn't small and in case of a group practice, the cost can increase by $200 for each physician. This can be reduced to some extent through our experts' help. The experts can delete the unnecessary details from it, which accrue additional costs.

Conclusion:

Due to our connections with the insurance companies, we can increase the pace of the credentialing process, so to decrease the time frame from six months to just two months.

Finally, as the credentialing process has to be renewed each year, by hiring a reliable agency for the job, the physicians don't have to focus on this aspect themselves. They are reminded by their agents when the time approaches. The agents will ask them the required documents and submit it before the deadline. Thus, taking all the stress away from the patients.

If you want your physicians to start working early, you will have no choice but to increase the pace of the credentialing process. The credentialing process and enrollment process is pretty demanding but with the right expertise, it can be done easily. Some insurance companies are part of a single pool. This means once the credentials of a physician are verified, he is added to the pool. Now, he doesn't have to apply to each insurance agency separately in order to receive payments. These pools are not easily accessible though, and a physician credential service can certainly help in this regard.