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.

Yes. When you sign up for credentialing with us, you get to choose exactly which panels you want, and don’t want, to be credentialed with.

We can help! One of our credentialing specialists 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.

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, Magellan, Tricare, United Healthcare, Humana, Coventry, Highmark, Health Net of California, Kaiser, Wellpoint, Wellcare, Regence Group, Value Options, Medicare, and many others.

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. We then follow up regularly with insurance companies to make sure that your credentialing applications are processed and approved as soon as possible.

 You bet! We have credentialed literally thousands of providers across the United States, including providers as far off as Alaska and Hawaii. No matter where your practice is, we have the experience needed to get you credentialed.

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

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!

A: Finding a closed panel can be frustrating. However, sometimes when panels say they are closed, they are still accepting providers, but on a limited basis. In the case of a panel saying that they are closed, we can still submit an appeal to the insurance company on your behalf. During an appeal, we will try to connect with the insurance company representative assigned to your area. We will then stress important parts of your qualifications and clinical practice. For instance, perhaps you have a specialty that the insurance company desires, or you are practicing in a neighborhood that is underserved. We do have success with many of our appeals. However, if a company is saying that their panel is closed, it might not be possible to get on the panel at that time.

Sometimes, but it’s highly unlikely. We have had success credentialing such providers on a limited basis—generally in areas that are very underserved. In most cases, insurance companies are looking to network exclusively with fully licensed healthcare providers.

Good question! When we use the term “panel,” we are using an abbreviation for insurance panel, which is the group of doctors who are networked with the insurance company and are able to provide services for patients that have that insurance. A panel could also be an EAP Panel, which is the same thing, but with an EAP (Employee Assistance Program).

Yes! Like insurance companies, EAPs are valuable third party payers to be credentialed with. The credentialing process is very similar to being credentialed with insurance companies. In fact, some of the major insurance companies also offer an EAP. Popular EAPs include: ComPsych, OptumHealth, Magellan, Horizon Health, Mines and Associates, ValueOptions, Cigna, and Harris-Rothenburg International.

Credentialing.com offers billing services to it franchisees. Learn more about the exciting benefits of opening a Credentialing.com Counseling center in your area, here: Counseling Franchise.

Physician Credentialing is the process of organizing and verifying a doctor’s professional records.

Healthcare providers need to be credentialed at least every three years. Some healthcare facilities or insurance companies perform recredentialing even more often.

Facilitate practice by physicians and others in the hospital or healthcare system. Under federal and state laws and regulations.

You should have the following data before you start the credentialing business.

1. Obtain a Tax ID from the IRS under the legal business name.
2. Register for a Type 2 National Provider Identifier (NPI) and also Type 1 NPI.
3. Register for a bank account under the legal business name.
4. Search for a location to open your practice.
5. Obtain Malpractice Insurance.
6. Speak with PrognoCIS Credentialing Department to start the credentialing and contracting process.

 The following steps work to get doctors credentialed with insurance.
1. Get your NPI1 number.
2. Know how you are billing for your services.
3. Obtain malpractice insurance.
4. Complete the CAQH application.
5. Register with Medicare.
6. Contact each insurance company with which you want to be in-network.

The companion piece to credentialing is “privileging,” which is the process of authorizing a licensed or certified healthcare practitioner’s specific scope of patient care services. Privileging is performed in conjunction with an evaluation of an individual’s clinical qualifications and/or performance.

Credentials Verification Organization (CVO) Accreditation ensures a meaningful, rigorous, and fair credentialing process that protects both patients and providers from poor credentialing practices.

Credentials Verification Organization (CVO) Accreditation ensures a meaningful, rigorous, and fair credentialing process that protects both patients and providers from poor credentialing practices.

The provider needs to obtain an NPI and then register with CAQH. Submit an online application to Aetna with all supporting documents. Allow 30-60 business days to complete the credentialing process.

Every four months, you will receive a request from CAQH to re-attest that all of the information in your application is correct.

Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. … The Contracting phase of enrollment is when the provider has been approved by Credentialing and is extended a contract for participation.

The nurse practitioner’s credentialing process involves the verification of education, licensure, certification, and reference checks. In order for a nurse practitioner to be eligible to bill government agencies and other commercial insurance companies, they must be credentialed. Initial credentialing involves a lot of paperwork

Council for Affordable Quality Healthcare (CAQH), a not-for-profit alliance of the nation’s leading health care plans and networks, has developed a single credentialing application and common application database. Instead of having to submit separate applications to each managed care organization, physicians can use the Universal Credentialing DataSource system to submit a “universal” credentialing application either electronically or in hard-copy format.

Credentials Verification Organization (CVO) Accreditation ensures a meaningful, rigorous, and fair credentialing process that protects both patients and providers from poor credentialing practices.

Yes, once physical therapists credentialed with any insurance provider will get all in-network payment benefits.

 Vendor credentialing is the process by which companies and facilities ensure that the vendors they work with have the appropriate background and training to access their facilities.

Medical staff credentialing is a process that involves establishing requirements and evaluating individual qualifications for entry into a particular medical staff status.