W-9, CAQH, & PECOS: Why Your Documents Are Your Biggest Credentialing Bottleneck (and How to Fix It)

Credentialing is a notoriously big, hairy game that can make any provider feel a knot in their stomach. You're not alone if you've ever felt overwhelmed by the "waiting game" of getting credentialed. Every provider just wants to know one thing: "When am I going to be able to start billing?".

While the process itself can take 60 to 120 days or more, you are often the biggest limiting factor in your own credentialing timeline. It all comes down to the one thing that is critically forgotten: your paperwork. If your information is not uniform across every single document, the process can become disjointed and grind to a halt. Payers will simply push your application back, which can cause another 30-day delay, a nightmare for any practice owner.

So, what are the most common document errors that can derail your credentialing journey? In the latest episode of the Claim Game, we sat down with Kay Ward, founder and CEO of Lanyard Health, to talk about the biggest bottlenecks and how you can fix them.

Your CAQH is Not Up to Date

CAQH is a critical data repository that can drive a lot of your payer enrollment. You need to ensure your CAQH is updated from beginning to end. Here’s what you need to pay close attention to:

• Employer Information: Make sure all of your employer information is updated, especially if there are any gaps in your history.

• Patient Limitations: You want to make sure your patient limitations are reflected in your CAQH.

• Global Authorization: This allows payers to pull your information whenever they need it.

Your W-9 is Incorrect

This might sound simple, but it is one of the biggest bottlenecks. When filling out your W-9, please make sure to include your practice name in line one. Your name should only be on line one if it is also your DBA name. If your W-9 is not filled out correctly, payers will immediately push it back. You’ll find yourself waiting another 30 days before they even respond, adding to the total processing time and further delaying your ability to bill and be reimbursed.

Your PECOS Account is Not in Your Name

When enrolling in Medicare, you need to ensure that you are the owner of your PECOS account as a private practice owner. According to Kay, getting this switched over is one of the hardest things to do because you're dealing with governmental payers. If you want to enroll in Medicare, please ensure that your PECOS reflects you as the private practice owner.

What You Can Do Today to Regain Control

The solution is simple, but not always easy: get your information in order. Start by compiling all your legal documentation in one place. This includes your W-9, CAQH login, and PECOS access. Making sure all of your legal documentation is in order is truly one of the biggest areas that can cause delays in provider enrollment.

It may feel like a mundane process that you have to do yourself. And while anyone can submit a credentialing application, it’s the chase that you have to go through to make sure it actually gets approved. Payers don’t care that you submitted an application; it’s up to you to follow up and get that contract. Your time is valuable; you shouldn’t have to become the highest-paid credentialer in your practice by spending time on credentialing instead of on clinical hours.

If you’re feeling lost and overwhelmed, a great actionable step you can take today is to reach out to a credentialing expert or consultant. Don’t wait until you’re in a debacle and not getting paid to seek support. Alternatively, you can subscribe to the Hourglass Learning Hub to download our DIY Credentialing resources and begin your credentialing journey with confidence.