Revalidation and recredentialing cause more confusion than almost any other administrative requirement providers face. You’ve spent years in school, completed your residency, passed your boards, and got credentialed with insurance companies so you can actually get paid for treating patients. Then someone tells you that you need to handle “revalidation” or “recredentialing,” and the paperwork […]
Credentialing Timelines, Medicare Revalidation, Payer Credentialing, PECOS, Provider Enrollment, Recredentialing
Providers can see patients while credentialing applications are pending, but the options for how they get paid, and the compliance requirements that apply, vary significantly depending on the arrangement. The three most common approaches are treating self-pay patients, working under locum tenens arrangements billed through a credentialed practice, and obtaining temporary or emergency privileges from […]
Credentialing Applications, Credentialing Challenges, Credentialing Timelines, Locum Tenens, Medical Credentialing
Healthcare consolidation is shifting the industry dramatically. Hospitals are merging with health systems, private practices are joining larger networks, and independent physicians are finding themselves part of massive organizational structures they never imagined joining just a decade ago. This wave of consolidation brings many changes, but one area that often gets overlooked is how these […]
Contract Negotiations, Credentialing Timelines, Payer Contracting
How long does medical credentialing take? With most commercial payers the answer is 90 to 120 days from a complete application to a decision, and some plans run as long as 150. Medicare publishes its own processing standards, which range from 15 days for a clean online application to 85 days when a site visit […]
CAQH, Credentialing Timelines, CVO, Primary Source Verification, Recredentialing
Outsourcing your credentialing starts with admitting that dealing with credentialing is difficult. No healthcare organization truly wants to maintain or balance it. It’s tedious, time-consuming, and can feel like an endless loop of paperwork and verification. Proper credentialing ensures that your practitioners are qualified and up-to-date, allowing them to get paid for their hard work. […]
Credentialing Timelines, HIPAA Compliance, Improved Turnaround, Lower Overhead Costs