1. Start the credentialing process early. Most commercial payers credentialing can be completed within 3 months, but that doesn’t mean you should take that long, as complications can arise. Payers have recently been merging into larger organizations. As a result a practice's ability to expedite an application has diminished. You’re working on the payer’s internal timeline for application processing, so it makes sense to allow additional time for any difficulties that occur.
2. Ensure that you application is complete. According to Joellen Scheid, an Anthem for Virginia credentialing manager, only 15 percent of applications are complete, while the rest are missing critical information required for processing. The most common areas of application deficits are missing data and obsolete data. Examples are:
- Missing work history and current work status
- Physician's practice and effective date with the practice
- Hospital privileges and covering colleagues
- Malpractice insurance details
3. Update and attest with CAQH for quicker processing that is easier to access. The Coalition for Affordable Quality Healthcare started its uniform credentialing program about 15 years ago. Since then, most payers in the nation have adopted this program. Physicians who regularly update and attest with Coalition for Affordable Quality Healthcare find credentialing and re-credentialing much easier. The Universal Provider Data (UPD) source is a part of CAQH's credentialing application database project. Its goal is to make provider credentialing more efficient for providers as well as for healthcare organizations. CAQH’s online database collects all provider information necessary for credentialing, with the goal of eliminating much of the administrative overhead, paperwork and errors that providers face during the process of credentialing.
Billing and insurance tasks contribute to a major portion of administrative costs for both providers and hospitals. Federally mandated CAQH CORE EFT and ERA Operating Rules also streamline and simplify provider payment and claim reconciliation.
4. Prepare for telemedicine credentialing. Some say telemedicine is the future of the healthcare industry. More than 36 million Americans have already used some form of it. It’s estimated that 70 percent of doctor visits can be handled over the phone — costing far less than an in person visit. The US military is one of the largest users, with about 55 percent of the Army's telehealth programs focused on behavior health.
When your goal is to provide widespread patient services in both rural and urban communities, you’ll be able to offer services to more people at lower cost with telehealth. But this type of credentialing can be especially tricky when granting privilege to practitioners for either first-time procedures or disaster service.
5. Abide by your state’s regulations. Each state has its own laws for timely credentialing, including in-state credentialing and reciprocity. Your state Medical Group Management Association can help you ensure you are adhering to your state's standards and using them to your advantage. Your credentialing process will be easier when you gather all the information you need on new providers up front. State requirements are quite varied. For example, in accordance with HCQA, NJ carriers must be willing to accept the NJ universal physician application form. Oregon’s universal credentialing application, created and maintained by the ACPCI eliminates the need to complete multiple unique applications for each health plan, hospital and insurer. Ironically, this state’s credentialing is not governed by the state.
In short, compiling all the information well ahead of time and making certain that it is both accurate and complete will save you from delays and administrative nightmares that can delay your provider credentialing process. Assembling your information to meet state, national and practice requirements and completing your documentation correctly the first time is likely to be the swiftest way to attain your goals.