3 Common Misconceptions About Credentialing

Posted by Diane McCutcheon on November 6, 2019
Diane McCutcheon
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Therapists put in years to fulfill the educational courses to become a therapist.  It is an awesome field to be in.  Just one thing about the education, the curriculum does not typically include classes on important administrative issues that are vital to a therapists starting their professional career.  Once they take and pass the exam to become a licensed therapist the search for employment begins. 

What they have not learned in their training so far are the requirements of becoming a provider with various insurance carriers, what it means to be provider and how to maintain providership if one moves on to a new employer.  This is where problems begin and end with not getting paid for the services the therapist provides.

Here are the most common misconceptions we encounter:

1. “I was credentialed with a previous employer, so I don’t need to be credentialed again.”

In private practice, most insurance carriers require that the practice enrolls and contracts with the carrier.  All therapists who will be seeing patients enrolled with that carrier must be credentialed with that insurance which will include adding and linking them to the group’s contract.

If a therapist leaves employment and goes to work for another practice, they must terminate their “link” to the previous practice.  If the new employer is a provider for some of the same insurance carriers as the previous employer the new employee can now make a change to be added and linked to the new group provider’s contract.  If there are insurance carriers they are not credentialed with they will need to start the credentialing process with the new carrier.


2. “Enrolling a new group practice is the same as enrolling individual providers.”

There is a difference between enrolling and contracting a company with an insurance carrier and enrolling and credentialing individual therapists.  Contracting involves signing an agreement with the insurance carrier to provide treatment to its members for an agreed upon rate as well as other stipulations. Enrolling a new company to obtain a group provider number often takes longer than enrolling an individual provider because of the more involved contracting application process.

Credentialing an individual with a contracted group provider includes verification of the applicant’s education, license and experience to provide high-quality care to their members.

3. “Once I am credentialed with an insurance company, I am credential with them for life.”

Being credentialed with an insurance carrier does not translate to being a provider forever. Many insurance carriers require re-credentialing in order to remain a provider. Re-credentialing is required to ensure that the provider’s information is updated and that they are in good standing with the insurance company. 

The re-credentialing process usually takes less time than the initial enrollment.  Insurance carriers have different re-credentialing timelines so it is important that when you are credentialed you note when you should be notified to start the re-credentialing process. 

Too many times we have seen provider contracts terminated because re-credentialing notices from insurance companies were ignored or not received. Don’t let this happen to you!

If you have questions or need help with credentialing, drop us a line at info@accountmattersma.com  to speak with one of our experts. We have the knowledge and tools to help you.

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Topics: Credentialing

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