Medical Credentialing: Missing Information and Disciplinary Action (Updated)

What happens if there’s missing information on a medical credentialing application?

A counselor submits an application to an insurance company, and a month later (yes, a month!) the insurance company gets back to him and lets him know that he is missing information. The counselor swears that he had all of the information he needed, but what happened? How is that possible? Insurance companies can lose documents and they can make mistakes. They are not perfect. They could have 10 people working on your application. A human being is working on your application, and they can misplace things.

Keep your work from getting lost in transit. Keep a copy of everything that you submit – whether it be a signature page or a resume, make sure that you keep a copy of everything that you submit. Also, follow up with the insurance company – when you can, always fax or electronically submit something, rather than send in a paper copy. Then, once you have submitted it, make sure you call the insurance company and make sure they received everything that you submitted.

Getting the application submitted is step 1, making sure that the insurance companies received all of the information is step 2, and continuing to follow up with the insurance companies is step 3.

Will disciplinary action hurt my chances for medical credentialing?

It is not a good thing, but it can happen. There are a number of 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.

Can interns be credentialed?

I am post-Master’s, 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.

Let us help you get credentialed


Have you had enough of fighting with insurance companies? Have you had enough of filling out provider applications? Just to have them lost or rejected. Are you drawing the line? We are happy to take hold of the wheel and get you credentialed. Give us a call at 1-855-664-5154 and speak with one of our credentialing specialists about getting started with our service. Or to learn more, we have posted a handful of helpful videos on our FAQ Credentialing Page.