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Navigating Recredentialing


Female therapist holding a sign that says "Navigating Recredentialing"

In the dynamic world of mental health care, staying up-to-date with the necessary credentialing and credentialing documentation is essential. Recredentialing might seem like a daunting task but we have designed this guide to assist you in navigating this process seamlessly. Whether you are a seasoned therapist or a fresh graduate, understanding the nuances of recredentialing is crucial for the continuity of your practice and the well-being of your clients.


Circumstances in Which You Would be Recredentialing

First, let’s define recredentialing. Recredentialing is the process by which healthcare professionals, including therapists, renew their credentials and licenses to continue practicing legally. These credentials typically include licenses, certifications, and memberships in professional organizations. Recredentialing is a periodic requirement, usually occurring every few years, and ensures that healthcare providers meet the necessary standards and qualifications to provide safe and effective care to their patients or clients. During recredentialing, professionals are required to submit updated documentation such as proof of continuing education, professional references, and license renewals to regulatory bodies or credentialing organizations for review and approval. This process helps maintain the quality and integrity of healthcare services by ensuring that practitioners stay current with industry standards and regulations.


Now that you have a firm understanding of what recredentialing is we can walk through the situations that would trigger the process of recredentialing.

Expiration of Credentials

When your current credentials are about to expire, recredentialing is essential to continue practicing legally. The most common expiration of credentials is updating your license with the state boards in which you practice. Ensuring that you are familiar with the regulatory bodies and boards that maintain your license is important because they publish the standards and timelines that you need to follow to maintain your license. Make sure that you stay up to date with those organizations and that you have reminders set when your license is due to renew.

Change of Practice

If you switch your practice location or employment, recredentialing with new details is vital. This is the area of recredentialing that surprises new therapists and seasoned therapists the most. It is not safe to assume that once you are credentialed with an insurance company that you will always be credentialed with that insurance company.


You will need to understand how you are credentialed with an insurance company at the practice you are currently working at to understand what needs to happen to recredential with an insurance company at a different practice. You will need to give yourself 6-9 months of time to appropriately recredential at a new location or practice if you make the switch.

Updates in Regulations

Changes in healthcare regulations or policies might require you to recredential to comply with the latest standards. With HIPAA, private insurance companies, and public insurance companies changing their policies all the time, it is important to stay up to date with what they are doing and what is required of you. The Centers for Medicare and Medicaid Services (CMS) is the governing body that oversees the changes for the government insurance agencies and usually sets the tempo for other changes that private insurers make. Staying plugged into what insurance companies and what the government is doing is really important to make sure you meet regulatory requirements.

Professional Development

Certain certifications require periodic recredentialing to ensure therapists are updated with the latest techniques and knowledge. Insurance companies and non-profit entities like CAQH will often ask you to reattest your growing body of knowledge as you gain CE credits and professional experience. Keeping and updating CAQH and the insurance companies that you are contracted with those certifications is critical to maintaining health recredentialing and will save you time if you are organized about that information.

How to Go About Recredentialing

Review Your Current Credentials

Start by reviewing your existing credentials and seek to understand the requirements for recredentialing. You will want to have a comprehensive understanding of your current credentials, education, and experience in order to begin the process of recredentialing.

Gather Necessary Documents

Collect all required documents, such as proof of continuing education, license renewal, and professional references. Use your research of the required documentation from the entities that you do business with to understand which documents and what format they need to be in.

Complete Application Forms (if needed)

Sometimes there are online forms, portals, or written applications that you will need to fill out before organizations will accept your recredentialing requests. Fill out the recredentialing application form accurately. Double-check all the information before submission. It might be a good idea to ask a colleague or employee to double check your work for completeness before submission.

Submit Required Documents

Send all the necessary documents along with your application to the appropriate credentialing body or organization according to the rules and regulations they lay out for submission.

Follow Up

Stay proactive by following up on your application. Contact the credentialing body if you do not receive any updates within the specified time frame. If possible you will want to build a relationship with a person specifically at the organization to correspond with. Nothing beats having a direct relationship with an employee or executive at a governing body.


What to do when Recredentialing is Complete

Congratulations! You’ve successfully completed the recredentialing process. After recredentialing, here’s what you need to do:

Update Your Practice Records

Ensure your updated credentials are reflected in your practice records and on your website if applicable. We recommend that you maintain a google drive or other filing system to keep all of your documents organized.

Notify Insurance Providers

Inform your insurance providers about your updated credentials to avoid any discrepancies in billing and claims. Insurance providers will update their online directories after you update them with updated credentials. The other reason you may want to update your credentials is that it helps maintain a paper trail when asking the insurance companies for a raise or rate increase.

Update Online Directories

If you are listed on therapy directories or websites, make sure your credentials are current to maintain your professional reputation.

Stay Informed

Keep yourself informed about any changes in regulations or requirements for future recredentialing to stay ahead of the game.


Conclusion

Navigating recredentialing might seem like a daunting task, but with careful preparation and attention to detail, you can smoothly transition through this process. By staying proactive, updating your records, and complying with the necessary regulations, you not only ensure the continuity of your practice but also uphold the trust your clients place in you.


Remember, recredentialing is not just a bureaucratic necessity; it’s an opportunity to reaffirm your commitment to excellence and continuous learning. Embrace it as a chance to grow, both professionally and personally.


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