AFFORDABLE CREDENTIALING SERVICE

For Medical Physicians & Other Healthcare Professionals in all States

Ridgefield Park, NJ 07660

201-373-1652

Contact Email: affordablecredservice@gmail.com

                                         https://www.affordablecredservice.com                                        

                                            

FREQUENTLY ASK QUESTIONS: CREDENTIALING / RE-CREDENTIALING

 

How long does the credentialing process take?

A: The credentialing process generally takes between 90-120 days. When you sign up for credentialing with us, we waste no time getting your applications completed and submitted to insurance companies.

 

Why would someone want credentialing?

A: Being credentialed with insurance panels means that you are able to see patients who have specific insurance plans and bill those insurance companies for the services you render. This can greatly increase the number of patients who can access your services.

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Do I get to choose the panels I want to be on?

A: Yes. When you sign up for credentialing with us, you get to choose exactly which panels you want, and do not want, to be credentialed with.

 

What is the process of getting credentialed with insurance companies?

A: Getting credentialed (on insurance panels) involves retrieving and filling-out a series of applications with insurance companies, submitting the applications to insurance companies, and then doing a lot of follow up.

      While it sounds simple, health providers often describe the process to be "nightmarish" as the application process rarely goes smoothly, and many providers find themselves resubmitting applications, fighting enrollment rejections, and spending a lot of time "on hold" with insurance companies.

         Additionally, many of the panels that you apply to may say that they are full or are not accepting providers with your specialty at the time. It is no secret that the process of medical credentialing is not something many health providers look forward to.

          While medical credentialing will probably never become your favorite pastime, there are a few things you can remember that will make the process easier.

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Do I get to choose the panels I want to be in?

A: Yes. When you sign up for credentialing with us, you get to choose exactly which panels you want, and do not want, to be credentialed with.

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What if I do not know which panels in my area are best for me?

A: We can help! One of our credentialing specialist will talk with you by phone and can help you to select the panels in your area that will be best fit for you and your practice.

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What are some of the more popular insurance companies?

A: The popularity of insurance companies varies depending on location. However, some of the most popular and largest insurance companies are:

• Blue Cross Blue Shield

• Aetna

• Cigna

• Independence Blue Cross

• Tricare

• UnitedHealthcare

• Humana

• Coventry

• Highmark

• Kaiser

• WellPoint

• WellCare

• Value Options

• Medicare

• And many others.

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How long Does the Credentialing process take?

A: The Credentialing process generally takes between 90-120 business days. When you sign up for credentialing with us, we waste no time getting your applications completed and submitted to insurance companies. We then follow up regularly with insurance companies to make sure that your credentialing applications are processed and approved as soon as possible.

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What is the credentialing process for physicians?

A: Credentialing is a process used to evaluate the qualifications and practice history of a doctor. This process includes a review of a doctor's completed education, training, residency and licenses. It also includes any certifications issued by a board in the doctor's area of specialty.

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Do you have experienced credentialing providers in my specialty?

A: We have credentialed healthcare providers of more than we can list: from chiropractors, to behavioral health providers to surgeons. If you are eligible to be credentialed, we can get you credentialed!

 

Am I guaranteed to get on the panels I choose?

A: If you are fully licensed, we should have no problem identifying plenty of insurance companies and Third Party payers for you to be credentialed with. In some areas, some panels can be very selective or closed. In these instances, we will talk with you about the likelihood of a successful credentialing process. We want you to get the most out of your credentialing investment.

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What if the insurance panel I want to be credentialed with is closed?

A: When an insurance company says that they are not accepting new providers, the situation may actually be that they are only opening these panels up on a very limited basis. This means that you can write a letter of appeal to that company, explaining your situation.

• Sometimes, panels are 100% closed, and you simply have to wait. Insurance companies typically re-evaluate their panels every 2 or 3 months so you may be able to get credentialed with them at some point.

If one is not board certified, are they eligible to be credentialed with insurance companies?

For some yes, for some no. The requirements are always different. For the major companies, Aetna, Blue Cross, United…it is going to be required for Medical Doctors.

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What is the difference between board certified and board eligible?

Board eligible can also be used for board certification. It means that you are eligible to take the board exam, but you have not yet. They want you to be Board eligible and take your exam while you are being credentialed or shortly after.

This does not apply to Master level mental health providers. Board certification for MA level is only beneficial; it is not required however, it does look good that you have become board certified.

 

Will Disciplinary Action hurt my chances for credentialing?

It is not a good thing, but it can happen. There are numbers of a different reasons this can happen. This is not necessarily going to be a problem for credentialing, but there will more than likely be a delay.

The insurance company will want a written explanation of what caused the action, what the allegations were, and the results of the action. This information has to be submitted directly to the insurance company.

Instead of going through the regular process, they have to go through a special committee to pass the provider along or not. The special committee that decides on credentialing is the reason for the delay.

 

How long before the first follow up with the insurance companies?

If you submit an application on Tuesday, should you be on the phone on Wednesday making sure they have all of your information?

The insurance companies do not have it right away, but it takes about 3 weeks for the application to go through the right department, be passed through contracting or credentialing, and then they have to upload that to their computer system. So, plan to make your phone calls around 3 weeks later, or even longer. Some insurance companies ask that you wait a minimum of 45 days before you follow up.

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I am post Master, but I do not have my license yet. Can I be credentialed?

Most often no. The major providers will not accept; however, there are some companies that will allow you to bill under your supervisor – Medicare in some states will allow this. But overall, as an intern you cannot be credentialed individually.

For example, in Massachusetts, the clinic cannot be a normal private practice; it has to be a Certified Community Medical Health Center.

So, for smaller practices, getting interns certified is a no go. They will not be able to get on BCBS, Aetna, or Cigna. For the most part, unless they are working with Medicare, Medicaid, or a state sanctioned company, interns won’t be able to get credentialed until they are licensed.