Medical Credentialing

Healthcare providers are tasked with an ongoing burden to establish and maintain their credentials with various third parties – Medicare and Medicare Advantage, Medicaid plans, and commercial payers including Aetna, Anthem, United Health Care, along with myriad smaller insurers.

This is a necessity, in part, because the ACA greatly expanded the number of people in the United States with health insurance. And it’s also true that patients generally expect their providers to be in-network, so that the patient can enjoy the maximum insurance benefit.

Medical Credentialing (or “provider enrollment”) is comprised of many technical steps, the overall intent of which is to demonstrate to an insurance company that the provider is licensed and trained in a specific specialty.  In addition, more recently, payers use the information associated with credentialing to inform their analytics processes, consistent with the move to quality.

While this is a vital component for successful clinical practice, becoming credentialed can be an arduous process and a distraction to office staff.  Enrollment applications are complex, ask arcane questions, and typically require consistent and timely follow up to have a successful outcome.  And as insurers try to find new ways to bring value to their consumers, plans are being added or changed frequently, and this requires active consideration by the provider as well as additional credentialing work from staff.

HCS staff can relieve the practice of the credentialing burden for a modest fee, and create economic benefit through efficient and organized processes that speed approvals.  Give us a call today at (888) 335-0427 to discuss your needs and discover how simple the process can be to create, update, and maintain your active insurance credentials.

FAQ’s:

How long does the process take?

It depends upon both the quality of information provided by the practice as well as how timely the insurance company can process information. We frequently see approvals within a month, but have also seen provider applications drag out for several months. It’s important to remember that many, but not all, insurance companies will approve credentialing as of the date a completed application is received.

Can I credential with any insurance company?

No. More and more insurance companies run closed panels for certain specialties, and will not credential addition providers into these specialties. Our staff generally are familiar with the closed and open panels.

Are any components of your service outsourced?

No, the credentialing department is located in Dayton, Ohio and all staffing is stateside.

How do I contact my credentialing representative?

We are available by phone or email during normal business hours, Monday – Friday.