Credentialing Blog Series Part 2 of 4: Pitfalls to Avoid!

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Main Points

• What is credentialing

• What are the steps in credentialing

• What are the pitfalls to avoid

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Next, you will need to understand the basic process for credentialing in order to apply the terms you have learned above. Here are some frequently asked questions about credentialing and their answers:

What is Credentialing: Credentialing, paneling, or payer enrollment is the process of showing and proving your credentials to an insurance company for the purpose of seeing patients on an in or out of network basis.

No insurance company is going to give a contract or payment to someone that they know nothing about. This process is about proving that you are who you say you are.

What are the steps in credentialing: Here are the general steps to credentialing

1. Collect all necessary documentation (see last month's blog post)

2. Locate the enrollment application for each insurance company via the insurance company's website

3. Fill out the application

4. Submit the application

5. Application is approved! The insurance company will send a contract.

6. Provider will sign the contract and send it back

7. The insurance company will send welcome materials to the provider

8. Provider sees patients and can be paid for those services

What are some pitfalls in credentialing to avoid: There are several pitfalls to avoid:

1. Expectation management is the biggest one. Aetna, for example, reserves 90-180 days for each stage of their credentialing process. So, knowing that and planning for it is the biggest pitfall to avoid.

2. Having all your information in one place will also speed up the process! Not having a document will cause substantial delays in the process.

3. Inconsistent follow-ups is another pitfall you will want to avoid. By following up regularly you help the insurance companies to push your application through the tunnel faster

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Look out for our next blog in the series: Group Credentialing!