MEDICAL PROVIDER CREDENTIALING

Medical Credentialing (sometimes referred to as “insurance credentialing” or “provider enrollment”) is the process of becoming affiliated with an insurance company so that you (the medical provider) can accept third party reimbursement.

While important for the success of a clinical practice, “getting credentialed” on insurance panels is often an unwelcome distraction from providing quality care to patients. Enrollment applications can be 30+ pages long, and to ensure smooth processing there’s a lot of necessary, time consuming, follow-up.

Our medical credentialing service exists to take the hassle out of getting “in network” with insurance panels. Thriveworks also offers Expert Medical Credentialing for Advanced Practice Nurses (APN), Physician Assistants (PA), Physicians (MD, DO, DPN).

HOW LONG DOES THE CREDENTIALING PROCESS TAKE?

The process of getting on insurance panels can be both challenging and lengthy. It generally takes between 3-4 months to submit the necessary paperwork, tender supplementary documentation, and correspond with insurance companies’ credentialing departments, before getting approved to join an insurance panel. However, at times the process can move along much faster. For example, Employee Assistant Programs (EAPs) tend to process in as little as 4 weeks. However, on the other hand, if an insurance company is running behind, or if there’s a problem with a physician’s/healthcare provider’s application, the credentialing process could take even longer than 4 months. Due to the large amount of paperwork and correspondence required, medical providers generally find the process to be very time consuming.

CAQH CREDENTIALING SERVICES

Council for Affordable Quality Healthcare (CAQH). It is essentially an online database that stores provider information. This information is granted to health insurance companies to make acquiring provider information more efficient. Instead of calling your office for your work history or a copy of your Medical License, they can go in and pull it directly from your file. 90% of the National Health Insurance Companies use CAQH and it is a prerequisite for their enrollment process. MaxRemind credentialing services will setup providers profile in CAQH as a part of regular credentialing application. MaxRemind will complete CAQH registration process without needing to wait on an insurance company to issue provider’s ID. Not having a completed CAQH application will delay provider’s enrollment with the insurance companies, preventing the provider from getting reimbursed for services.
Aetna
Medicare
Blue Cross Blue Shield
Medical Mutual
Humana
Cigna