Why Does Credentialing Take so Long?

Posted by Daniel Ramsey on March 24, 2021
Daniel Ramsey
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Credentialing has never been synonymous with fast. Many healthcare providers get frustrated with the long wait times (90-120 days) associated becoming an in-network group/provider. In this article, we’ll explain why the credentialing process takes so long even in the digital age, so you can better prepare for opening your practice or hiring additional providers.

Submitting Initial Applications

Each insurance company has their own credentialing application. Applications are either found on the insurance company’s website or requested via phone, email or online form. If the application has be requested, it could take up to 30 days for the insurance company to respond. Applications can take an hour or more to complete. Once you submit the application via fax, email, or provider portal, the real waiting game begins.

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Insurance Verification Process

There is no guarantee that your application will begin processing as soon as it is received since insurance companies receive numerous applications every month. While it is recommended to call and confirm your application was received, don’t expect there to be a ton of progress.

Once the insurance company has begun processing your credentialing application, they will perform primary source verification which includes verifying the validity of your license, diploma, and resume. The insurance company will use the CAQH Proview profile along with your application to verify this information which is why it is so important to have your providers maintain their CAQH Proview.

The insurance company will contact the license board, college registrars’ offices, and past employers to verify your information. This can take a significant amount of time especially if the credentialing department can’t confirm the information on the first attempt.

The insurance company’s internal timeline can take 60-90 days. This timeline does not include delays for incomplete or inaccurate applications.

Credentialing Committee Meetings

Once the group or individual credentialing application has been processed, it goes to the credentialing committee for final approval. Each insurance company is different so their credentialing committees may only meet monthly or quarterly. This can add significant delays to your credentialing application. For example, if your application is ready for committee at the beginning of the month but they don’t meet until the last week of the month, your application will just sit there for nearly three weeks.

In-Network Status

Congrats, you waited 30 days to receive your application, 60 days for the insurance company to verify your information, and 30 days for the credentialing committee to approve your enrollment. You can now begin treating patients as an in-network provider.

It is difficult to expedite the credentialing process but there are ways to make the process as stress-free as possible. We recommend having a dedicated staff member manage your practice’s credentialing or utilizing a credentialing expert such as Account Matters to get your group or providers in-network. Check out this page to learn more.

Topics: Credentialing, Management

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