How To Simplify the Provider Credentialing Process

Navigating the credentialing process can be complex and time-consuming if you haven’t experienced it before. At Physician Practice Specialists, we provide healthcare facilities and staff with services to streamline the credentialing process. Here are some tips on how to manage the provider credentialing process:

What Is Involved in the Credentialing Process?

The credentialing process involves getting approval from an insurance company to provide medical services to their clients. During this process, you will submit an application to the insurance company with information like a CAQH profile, tax ID, a list of current payers, and the practice’s Medicare PTAN. The credentialing process will require different documents, depending on if you are opening a new practice or adding a new provider to your practice. A credentialing company can advise you on the necessary documents, the expected timeline, and any possible issues with approval. You may receive approval and be fully credentialed within 45-60 days of the application.

Gather and Organize Required Documents

A well-organized and complete set of required documents can help expedite the credentialing process. Gather all necessary paperwork, including medical licenses, board certifications, education transcripts, malpractice insurance, and professional references. Organize these documents in a centralized location to facilitate easy access and submission to insurance companies when requested. You can digitize your documents to avoid losing the official paperwork during shipping. To avoid delays, make sure you submit all documents required at the same time.

Partner With Credentialing Experts

Letting an expert in credentialing guide you through the process will help you avoid pitfalls and delays. These specialists possess in-depth knowledge of the credentialing requirements for various insurance networks and can guide you through the paperwork, submission, and follow-up stages. Their expertise verifies that all necessary information is accurate and complete, reducing the risk of delays or denials. These professionals can help you through the entire process, taking on administrative burdens and decreasing the chance of errors or mistakes. 

When your credentialing procedure is efficiently run, you can save time by avoiding the need to file insurance company objections and resubmit claims. Employing credentialing firms allows your administration to focus on more urgent issues by avoiding the unnecessary complication of learning the credentialing process. 

Utilize Technology and Electronic Platforms

Leveraging technology and electronic platforms can save time during the credentialing process. Electronic submissions of documents can not only help with organization but allow for smoother submission instead of using traditional mail. Physician Practice Specialists offers secure online portals where you can upload your documents and track the progress of your application in real-time. Utilizing electronic platforms reduces paperwork, saves time, and enables real-time tracking of your application’s progress.

Be Proactive in Communication

Quick responses to any inquiries or requests for additional information can help provide a seamless flow of credentialing communication. When you submit your documents, verify that they clearly reveal all of the necessary information to avoid redundant back-and-forth communication. Reach out to the insurance representative or your credentialing company if you are unable to access information like your board certification or PLI certificate. With Physician Practice Specialists, you will communicate directly with a customer service representative rather than an automated system or outsourced agency.

Verify and Update Information

Before submitting your application, verify that all provided information is accurate and up-to-date to avoid potential denials. Taking the time to double-check your documentation accuracy can lessen the possibility of denial due to insufficient information. Periodically review your credentialing applications’ status to verify that they are progressing smoothly. If any issues or delays arise, address them promptly to keep the process on track. Once successfully credentialed, maintain an organized system for re-credentialing. Keep track of your expected timeline and gather updated documentation well in advance to streamline future recertification.

Set Up Your Own System

You can decide to establish a credentialing procedure for the administrative division of your healthcare business. Design your provider credentialing services procedure with the help of our experts. Our consulting team can assist you in customizing your processes to meet your credentialing requirements. We have expertise certifying medical professionals and organizations nationwide, so we can attest that your certifying procedure complies with all industry requirements. Developing a successful credentialing approach is a valuable time management technique, whether or not you work with a credentialing company.

Provider Credentialing Made Simple

Physician Practice Specialists can help you make sure you and your employees are properly certified. Credentialing enables you to maintain compliance and time management of your practice. Our team of professionals will help you streamline the credentialing process. You can arrange a one-on-one appointment with a member of our staff, at which time we can explain the credentialing procedure to you and offer you a start-up checklist to complete. Contact us today to learn more about how our outsourced credentialing services can benefit you and your practice.