Credentialing FAQ
How do I know if my current credentialing service is working?
Chances are it’s not working for you now or you wouldn’t be looking at our website. Typically from the time an application is submitted it takes 90 days to be processed by the insurance company. If you have received a denial it could be because the panel closed (and you may need to appeal), your application was incomplete or your CAQH is set-up incorrectly, in which case your current credentialing service may not be working for you.
What does the credentialing process look like?
We gather all your pertinent documents and information. Once we have updated your CAQH and NPI accounts we will then submit your information to the insurance/EAP companies. Once submitted the credentialing process takes about 90-120 days to be processed. During this time we will follow-up with the insurance panels to confirm they have received your information and are processing it. We will request expediency if needed.
How much does it cost to have a provider credentialed?
The cost varies depending on several factors. We can provide you with an estimate based on whether we are credentialing individual providers or a group. If it’s a group, there are additional factors to consider; is the business already set up with a TIN (tax identification number), how many providers are there, is the group currently credentialed as a group, etc. Our hourly rate includes reviewing and updating your NPI & CAQH accounts as needed. We submit your applications to the requested panels and follow-up as needed. If you are interested in receiving an estimate please email us at credentialing@practiceresource.net or call us at 513-273-9350.
What panels do you credential for?
We are able to credential with most managed care providers and many EAP (employee assistance programs) companies.
Do you offer credentialing for Medicaid and Medicare?
We offer mental health credentialing for both Medicaid and Medicare.
Whom do I actually work with when I become credentialed?
You will be working with our credentialing team. Our team has over 10 years experience credentialing mental health providers and group practices and will keep you informed of your status with each panel.
How long does it take to get credentialed?
On average, once we have the necessary documents from the provider, we can update accounts and submit applications to the insurance panels within 1-2 weeks. If signatures are needed from the provider, it may take more time to coordinate obtaining them. Once applications are submitted, the insurance companies typically take 90-120 days to process them. There are some companies that have multi-tier levels of processing so they do take longer. Please email us at credentialing@practiceresource.net or call us at 513-273-9350 if you have a question regarding a specific panel and their time frame.
Who are your clients?
We have clients consisting of large and small private practices and independent providers. Some clients utilize our services only to impanel with a couple insurance companies and then take over with follow-up and maintenance themselves. Other clients utilize our services on an ongoing basis. We maintain their re-credentialing and receive any credentialing documents from the insurance companies so they don’t have to see them or deal with them. They prefer the “hands-off” approach.
