The following is a generalized overview of the credentialing process:
- Complete all initial and re-credentialing applications;
- Mail or electronically submit applications with tracking number to third party payers;
- Follow-up with payer to ensure receipt of application;
- Maintain consistent communication through the credentialing process with payers;
- Report to clients for each entity at client-determined intervals; and
- Communicate the confirmation of participation/privileges to clients.
By outsourcing your credentialing process, you will free up your staff from using a large amount of time filling out unmanageable credentialing or re-credentialing applications. We will make sure you will never miss another filing or recredentialing deadline.
Health Plan Credentialing Process – An Overview:Step 1 Compile documentation and information from provider Step 2 Submit physician application and documentation to health plan Step 3 Health plan conducts primary source verification
- All licenses (state, DEA, CDS)
- Education, training (internship, residency, fellowship)
- Hospital staff privileges (current and previous)
- Malpractice insurance coverage (for at least 5 years)
- Claim(s) history (for at least 10 years)
- Work history (since finishing training)
- Any sanctions with Medicare or MediCaid