Why Credentialing Costs Vary by Provider Type?

Credex Healthcare provides top-quality credentialing services for all types of providers. Different provider categories face varying credentialing costs; here’s why:

We understand your needs, whether you’re a physician, a nurse practitioner, or a behavioral health professional. But a common question we hear is why credentialing costs differ based on provider type. We’ll explain this step-by-step in this blog. No confusing jargon, just clear answers. So, let’s get started.

What Is Credentialing and Why Does It Matter?

One major initiative for an accredited healthcare provider is credentialing. This process involves insurance companies, hospitals, and patients confirming that you are qualified to practice. It includes reviewing your education, licenses, work experience, and other credentials. Without credentialing, you cannot join insurance panels or bill for services. It typically results in little income from large insurers, which means fewer patients, slow growth, and increased stress.

Now, here’s the interesting part. Credentialing isn’t the same for everyone. A psychiatrist might earn more than a family doctor. A surgeon could be paid more than a therapist. But why? Let’s explore that a bit.

General Credentialing Process Overview

Before discussing costs, it’s helpful to look at a typical credentialing process. The same basics apply to all providers. You fill out forms, submit documents, and negotiate with payers for approval. A standard credentialing process usually includes:

– Creating your CAQH profile

– Submitting enrollment forms to payers

– Undergoing background checks

– Confirming DEA and licensing

– Verifying sources

It may sound simple, but it takes a lot of work. It requires time and effort, and that’s what you’re paying for. However, credentialing isn’t the same for everyone. The more complicated your history, the longer it will take. And that’s when it becomes more costly.

Physician Credentialing Fees

Doctors, and more specifically specialists, usually face the highest charges for credentialing. Why? Because they tend to participate in more insurance panels. They can also practice in hospitals or even across several clinics. Their profiles are more detailed, including information from med school, residency, and fellowships. This results in more paperwork, communication, and administrative back-and-forth with insurance providers.

Additionally, the fees physicians pay during the credentialing process increase when they apply in multiple states or have had past licensing issues. All these factors add to the workload. While the credentialing cost per provider type may be higher for doctors in such cases, it is reasonable for rapid expansion.

Nurse Practitioner Credentialing Costs

Nurse practitioners (NPs) play a vital role in modern healthcare. Their accreditation can be less expensive than that of physicians. However, it is not easily achieved. NPs must be qualified through their education, licenses, certifications, and other credentials. It might be quicker if they are recent graduates. But when they operate in multiple locations or expand into new states, the process becomes more complicated. Some NPs also need help establishing a new practice, which may include credentialing and registration. As a result, the costs of nurse practitioner credentialing can vary depending on their specific needs NP.

Behavioral Health Credentialing Expenses

It is an emerging profession, and the cost of behavioral health credentialing is increasing. While credentialing for psychologists, therapists, and counselors can sometimes be cheaper, it is not always the case. These providers often face challenging regulations. Insurance companies require very precise documentation and may reject submissions if even a single item is missing.

Furthermore, behavioral care providers frequently see patients both in person and online, as well as in group settings. This leads to more paperwork, and in most cases, their credentialing is linked to Medicare and Medicaid, which takes more time to verify. The same process consumes additional time and effort, and expense.

Therapists and Allied Health Professionals

Physical therapists, occupational therapists, and speech therapists should also be credentialed. They typically take less time than doctors or psychologists. However, this depends on how many insurance companies they want to be listed with. Additionally, if they change states or work with children or special populations, they need to take extra steps. While some providers may be cheaper through certain credentialing options, this does not mean they are less important. Proper credentialing can help prevent billing delays and denials time.

Specialist vs. Generalist Cost Comparison

The simple rule of thumb: specialists tend to pay higher prices than general providers. Why? The reason is that their histories are longer and more detailed. A general doctor might work with five insurance companies, while a specialist could work with ten different insurance companies. The increase in applications means more hours and thus higher fees.

Additionally, insurance companies tend to be more cautious with specialist services. This leads to more questions, corrections, and follow-ups. Therefore, the cost comparison between specialists and generalists usually favors the generalists when it comes to costs.

Factors That Cause Price Variations

You now understand that provider type influences the price. Still, that is not everything. Here are some additional reasons why credentialing costs vary: 

• The location matters. Providers in urban areas might pay more due to high competition and complex paperwork. Rural providers may pay less, but that’s not always the case. 
• The number of states you work in also affects costs. The more states you’re registered in, the more license checks are needed. 
• How you set up your practice is important. Small individual providers are likely to pay less compared to large clinics with many providers. 
• The number of insurance panels you join is key. The more associations you want to be part of, the more labor-intensive it becomes. 
• Your priorities matter too. Rush credentialing can become costly if you need it quickly.

Choosing the Right Credentialing Partner

Also, you don’t have to handle all this on your own. That’s where Credex Healthcare comes in. We simplify credentialing, getting it right the first time, securely and quickly. We work with doctors, nurse practitioners, behavioral health providers, and all types in between. Furthermore, we offer transparent, upfront pricing. We also tell you exactly what you need to know. And we won’t leave you in the dark. No matter how much help you need, whether it’s for a single panel or enrolling with a provider, we’re here to assist you.

Conclusion

This is why not all providers will be charged the same for credentialing. The cost of credentialing varies based on provider type, your employment status, your work history, and your setup. Doctors, NPs, and therapists will face different rules, schedules, and documentation requirements.

However, one thing remains unchanged: Credex Healthcare is your best partner. We understand what each type of provider needs. We save you time. Not only that, but we also reduce stress. And we can help you get paid faster.

FAQs:

Q1: Are physicians charged more in terms of credentialing than nurse practitioners?

Yes, doctors are usually more thorough because their credentialing process takes more time. They tend to have longer histories of training, hospital affiliations, and accept more panel insurances.

Q2: Why does specialty influence the fees of credentialing?

Specialists are more likely to charge high fees because they handle credentialing issues that involve more paperwork, additional verifications, and strict payer requirements. The more complex the process, the more time and cost are involved.

Q3: Do behavioral certifications have lower expenses?

Not always. There is a tendency for complex rules and extended timelines faced by behavioral health providers in particular and Medicaid in general. That may escalate expenditures despite the nature of the provider being a non-physician.

Q4: Is it possible to negotiate a credentialing fee?

Yes, especially when handling multi-provider credentialing or bundled services. We offer tailor-made plans that fit your needs and budget at Credex Healthcare.

Q5: How is it least expensive to get credentialed?

Partnering with a credible credentialing provider like Credex Healthcare saves money over time. We help you avoid time-consuming processes and rejections that could cost you more later.