How healthy is your practice with your credentialing enrollments?

Top Five Reasons You May Have Enrollment Issues:

• CAQH is not updated timely for your providers
• Locations and address updates are not reported timely
• Not tracking recredentialing dates with in-network insurances
• Submitting recredentialing applications outside of the deadline
• Assuming new hires are already credentialed

• CAQH is not updated timely for your providers: Many commercial insurances get their updates and manage the re-credentialing of providers through CAQH without your knowledge. Having the information attested every 60-90 days is essential for the provider to remain in-network.

• Not tracking recredentialing dates with in-network insurances: Medicare, Medicaid, smaller plans, as well as managed care groups require re-credentialing every 3-5 years. Be sure you know when the recredentialing dates are for each provider in case you are not directly notified. If the re-credentialing date is missed, the insurance will drop the provider from the plan and they will need to credential from scratch, which is a timeline of 90-150 days.

• Locations and address updates are not reported timely: If you are filing an address on a claim that the insurance does not recognize, you may receive denials on those claims. Reporting new locations to the insurances is essential for claims payments.

• Submitting re-credentialing applications outside of the deadline: Typically, a request for re-credentialing information has a 90 day timeline. If you do not submit the information back to the insurance company by their deadline, you could be dropped from the network and must reapply as a new provider.

• Assuming new hires are already credentialed: New providers hired by your organization may be credentialed with the same insurances as your practice but they must be added to your insurance contracts. A credentialed provider will need to be linked to your organization by an insurance company. If the provider is credentialed out of the geographical area from your organization, you may need to enroll that provider as a new provider with the insurance.

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At 1st Credentialing, we look forward to partnering with you today!