Credentialing Procedure for Adding New Provider

1. Credentialing Procedure for Adding New Provider  Medical Billers and Coders

2. To bill, any healthcare service to an insurance carrier, the provider, or the health organization should be credentialed by that insurance carrier. Provider credentialing is one of the most important processes of practice management. In provider credentialing, you are enrolled in the insurance carrier’s network and get authorized to render services to the patients who have enrolled with the insurance carrier. Physician credentialing is the process of validating the provider’s professional records including qualifications, experience, certifications, license, and other records. Credentialing Procedure in healthcare is the process by which medical organizations verify the credentials of healthcare providers to ensure they have the required licenses, certifications, and skills to properly care for patients.

3. Most providers are under impression that credentialing is a one-time process but it’s not, credentialing will happen in the following scenarios:   • Initial credentialing when a healthcare provider joins a practice or starts his own practice • When a physician moves from one practice group to another • When a physician or a health care provider enrolls with a new insurance carrier • Recredentialing to maintain their credentials • With an exhaustive list of information to be collected, submitted, and verified, credentialing is a tedious and lengthy process and may usually take about 2 to 4 months to get credentialed. Sometimes, it may even get delayed by 6 months when documentation is not done completely, and the file goes back and forth as well as processing delays from the insurance end.

4. Credentialing Procedure for Adding New Provider • Step by step credentialing procedure for adding a new provider to your current healthcare practice is as follows: • Provide an updated and attested CAQH profile, with new practice affiliation (including start date) listed. Additionally, the provider’s license and DEA must also be updated with the new state they’ll be working in if this is different from their initial affiliation. • Provide a list of payers they are currently affiliated with, including commercial, Medicare Advantage, Medicaid HMOs, worker’s compensation, Tricare, as well as any TPAs. • Provider tax ID to insurance carriers and update your CAQH profile with this information as well as hospital credentialing is necessary for some insurance payers or specialty providers, the list of hospitals you intend to have privileges with will need to be updated in your CAQH profile. If you don’t intend on having hospital privileges for your practice, you will need to create an admitting arrangement with a provider or decide which hospitalist or ER in your area you will be utilizing for admitting arrangements.

5. Provide new or updated malpractice policy and update in your CAQH profile. • Provide the group’s primary billing type, which will be listed on applications with a Tax ID. • Provide the group’s Medicare PTAN that you plan to be included on, which will be listed on your Medicare application linked to the new group.

6. Email : info@medicalbillersandcoders.com Fax no: 888-316-4566 Toll Free no: 888-357-3226 AddressWilmington, 108 West, 13th street, Wilmington, DE 19801Texas, 539 W. Commerce St #1482 Dallas, TX 75208