At 1ˢᵗ Credentialing we know that when our clients place their trust in us, we take that responsibility seriously by communicating with our clients to create a transparent and collaborative partnership.
Healthcare organizations of every size realize that hiring 1ˢᵗ Credentialing is the most economical and efficient way to solve their credentialing needs. We have the training, expertise and commitment it takes to keep a complex process moving forward at all times.
1ˢᵗ Credentialing supports healthcare practices of all sizes - from health systems, to community hospitals, to large group practices, to smaller organizations. We help get your providers up and practicing as fast as possible.
Learning more about the credentialing process benefits us and our clients. 1ˢᵗ Credentialing offers regular videos and newsletter updates to bring our clients and those interested in innovations in credentialing up to speed.
In this part of payer enrollment basics for new practices, we will discuss how critical it is to start the insurance enrollment process early.
Provider Enrollment for Commercial Insurance Networks
Typically, it can take 90 days to be enrolled with commercial carriers. Submit a participation request to each health plan using its own application process. Some plans use CAQH in conjunction with an application or a state standardized application while others have their own unique form.
Before you sign up with the various insurers, make sure that you review each contract thoroughly. While in the contracting phase, you’ll have the opportunity to negotiate the insurer’s fees. This may mean a delay in the overall credentialing and contracting process as the negotiating process can take up to 6 months.
Once your agreement is approved and returned to the network, your tax ID is in the system for your organization and a contract with fee schedule is in place. Now it’s time to credential the providers to the contract, which is when carriers
who have provider numbers will issue them. Each provider will get a separate effective date that determines how far back the billing can go.
Payer Enrollment in Medicaid, Medicare and Tricare
The provider enrollment process for government health programs is different than that of commercial insurers. Government plans have standard forms that must be completed and processed through their own systems. Medicare enrollment is handled by the PECOS online portal via the Centers for Medicare and Medicaid Services, or CMS. The Medicare enrollment process is extensive and attention to detail is a must.
Medicaid is a state process and many states have their own online portals.
The payer enrollment process is lengthy. Remember, you won’t be able to receive “in-network” reimbursements until your contract is in effect and your providers are credentialed.
Let Us Manage All Your Payer Enrollment Services
If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.
Our credentialing experts are here to help you assess exactly which solutions you need and let you know how inexpensively we could put you on the right track. 1ˢᵗ Credentialing includes primary source verification and payor enrollment for all insurance networks including Medicare, Medicaid, Medi-Cal and insurance networks. Don’t wait another minute, contact our terrific team today!