Medical credentialing can be a mysterious world that can seem to providers like it is guarded by a large 3 headed dog and closed to everyone in the world. While this is an extreme view of credentialing, it certainly can be a daunting task to try and get on insurance panels on your own. Here at Thriveworks there are a few questions that we are consistently asked.
What is a CAQH?
The CAQH is an important aspect of all medical credentialing and should be completely set up in order to even begin the credentialing process. In order to get a CAQH ID so that one can complete a profile, one must contact an insurance company for that number. We recommend doing this with Humana or Aetna. Once you have received your ID, you will go to www.caqh.org and complete your profile. This profile is essentially your application for a lot of insurance companies. You will want to make sure that all of the information within the profile is accurate. When you go to apply to the many different insurance companies, there will be a place on you initial request to join the company that you will put your CAQH number.
How long does credentialing take?
Almost every person we work with wants to know how fast they can get onto insurance panels. This depends mainly on the panel but overall it is going to take 4-5 months to be fully credentialed and ready to accept patients that use that insurance. There are many facets to credentialing and each piece takes 30 plus days to process through the insurance company. Be prepared for this process to take time.
Why is this insurance panel closed?
This is another answer that can vary dependent on what panel and what state you are talking about. Currently, many insurance panels are closed due to the amount of providers they currently have. There are not enough patients in the network area to allow a new provider on. The next question after this one is when will it open back up. The majority of companies will ask that you try again in 6 months and we recommend that as well. You never know when a change may occur and a company opens back up.
What will help my appeal be accepted?
This again depends on your location and panel. It is known that if you have a unique specialty and or speak more than one language, many insurance companies will be willing to accept your appeal and allow you on the panel.
What documents are required by the insurance companies?
There are several documents that all insurance companies will ask for when processing your credentialing application. They will require a resume in month/year format and an explanation if you have a gap in your work history. They will want a copy of your current liability insurance, current license that has your expiration date on it, and a diploma from your highest earned degree.