One of the most important steps for onboarding a new provider for your practice is credentialing. Failing to get a new provider credentialed by payers could result in no payment for services unless a patient’s plan allows for out-of-network benefits. Credentialing involves verifying the facts such as the state licensure, medical school certificate, malpractice carriers, and also includes a background investigation of the physician’s financial and criminal history.
The process can be both slow and tedious, and delays and mistakes can easily cost your practice money. It’s essential to prevent rejections while working to speed up the process. If your practice is credentialing new providers in 2019, we’ve put together some top strategies to make this whole process go just a little bit faster.
1 – Early Preparation
As soon as you know you have a new provider coming into your practice, start preparing for the credentialing process early. Get all the information you need from the incoming provider in advance, such as professional references, licensure documentation, and updated CV, malpractice information, etc. Don’t put it off until a couple months before they start with your practices. Credentialing doesn’t always go smoothly, so you want to be well prepared. Keep in mind, some payers don’t deal with credentialing until 60-90 days before they begin, but you still can save time by doing your due diligence and preparing in advance.
2 – Link a Provider’s Start Date to Credentialing
Your incoming provider probably has a guaranteed salary, so they may not be worried about how fast the credentialing process goes. However, anything that slows down credentialing can impact the finances of your practice. To ensure you receiving everything you need from the new provider, considering linking a provider’s start date to credentialing. For example, determine that the provider cannot begin any sooner than 120 days after they have submitted all of the information and documents required to be fully credentialed.
3 – Get to Know the Payers’ Credentialing Staff
One of the best ways to speed up the credentialing process is to have your staff take the time to get to know the payers’ credentialing staff. This way you can notify them when you submit a new application. If you know the staff, they’ll be more likely to work with you quickly at times when they’re overloaded with new applications. Getting on a first name basis with these individuals also gives you the ability to check in with them weekly to ensure things are going smoothly and they have everything they need.
4 – Ask for More References
Ask for more than just the routine three references from the provider, and make sure they’re received with everything else. Lagging references can end up slowing down the entire process because many payers won’t even begin the process until they have everything, including those references. While most payers will require three references, some may ask for five, and asking for more references up front can help in case you have a problem with one of the references.
5 – Know the Common Errors
Sometimes it’s simple, preventable errors that slow down the credentialing process. One of the best things your practice can do is know the common mistakes so you can avoid them. According to Physicians Practice, just a few of the most common oversights and errors include:
- Submitting a DEA license or number that’s expired
- Failing to fully complete forms
- Gaps in work history without explanation for those gaps
- Providing an incomplete malpractice history
- Professional references are missing
- Data entry errors
6 – Stay Informed on State Regulations
Make sure you stay informed on your state’s regulations. For example, certain states may have reciprocity, which means that if a provider was credentialed by a payer in another state, they can go through the process faster in another state with that payer. Other states allow providers to bill for their services while going through the credentialing process.
7 – Consider Outsourcing Your Credentialing This Year
If you’re looking for ways to speed up the provider credentialing process in 2019, one of the best options is to consider outsourcing your credentialing. Credentialing services are experts in navigating this process, which means they can save you a lot of time by ensuring everything is don’t the right way the very first time. Using a quality service can cut this process by weeks or even months, which means it’s well worth the investment, particularly when you need it done fast.
Remember, any delays in the credentialing process can have a negative impact on your practice’s bottom line. As long as a provider stays un-credentialed, they’re only overhead to the practice instead of bringing in money. While the process can be long and tedious, there are ways to mitigate delays to expedite it. Begin the process early, make sure you have all the data needed, ensure common errors aren’t made, and keep track of the process with payers. When time is of the essence, consider outsourcing your credentialing – it can save both time and money in the long run.
At M-Scribe, we specialize in provider credentialing, ensuring your practice can get back to focusing on what you do best – treating patients. To learn more about how we can help you simplify the provider credentialing process, contact M-Scribe today for more information or call us at 770-666-0470.