Why Credentialing Costs Vary by Provider Type?

Credex Healthcare offers the finest credentialing firm to all kinds of providers. Different provider types face different credentialing costs, here is why:

 We know what you need, and whatever you are a physician, or nurse practitioner, or one of these behavioral health professionals. However, a large question usually asked of us is: why does the cost of credentialing vary according to type of provider? We are going to do that in a step-by-step manner with the help of this blog. No intertwined lingo. Only pure answers. Then, here we go.

What Is Credentialing and Why Does It Matter?

One of the major initiatives of an accredited healthcare provider is credentialing. This is where the insurance companies, hospitals and patients gain the knowledge that you are eligible to practice your job. This is conducted to scrutinize your education, licenses, and work experience, etc. You cannot be a part of insurance panels or bill services without credentialing. It will come as no pay by large insurers. That also implies low numbers of patients, not much growth, and a considerable amount of stress.

Now, this is the interesting part. Credentialing does not come at one price. A psychiatrist may earn more than a family doctor. A surgeon may be higher paid than a therapist. But why? Now, we can unpack that a bit.

General Credentialing Process Overview

Prior to speaking about cost, we should see a typical list of what credentialing involves. The same is true of all providers at the core. You complete forms, download papers and negotiate with payers to be approved. A standard credentialing procedure will involve:

• Creating your CAQH profile
• Submission of enrolment forms to payers
• Background checks
• DEA and license confirmation
• checking the sources

It sounds easier said than done–there is a lot of work. It costs time and effort, this is what is being paid. Nonetheless, the credentialing route does not apply to everyone. The more complicated the history, the longer it will last. And this is where it becomes more expensive.

Physician Credentialing Fees

Doctors, and more specifically specialists, are usually charged the highest price to credential. Why? They tend to participate in more insurance panels because they do. They can also practice in hospitals or even in several clinics. Their profiles are more elaborate. It is a lot of information to go over med school to residency to fellowships. This can only mean more paperwork, more communication and more paper-pusher with insurance providers.

In addition, the amount of fees to be paid by the physicians during the process of physician credentialing increases when the doctors apply to numerous states or when they have had problems concerning their licenses in the past. All of those increase the amount of hours in the work. In that case, as a doctor, your credentialing cost per provider type might be higher but it is reasonable when it comes to speedy expansion.

Nurse Practitioner Credentialing Costs

Nurse practitioners (NPs) play an important role in modern healthcare. Their accreditation may be cheaper than that of physicians. Nevertheless, it does not happen easily. NPs should be qualified in regard to their education, licenses, and certifications and so on. It could be faster in case they are new out of school. However, when they operate in numerous locations or when they are opening more states, then there is complexity.

There are also NPs who require assistance in establishing a new practice. That may encompass credentialing and registration. Thus, the costs of nurse practitioner credentialing may increase or remain low depending on the needs of the NP.

Behavioral Health Credentialing Expenses

It is an emerging profession, and there is an increasing cost of behavioral health credentialing. Psychologists, therapists and counselor credentialing can be cheaper but not necessarily so. Such providers are usually confronted with problematic regulations. The insurance firms require extremely precise documents and can decline them in case of the loss of a single object.

Moreover, behavioral care providers frequently meet patients both in person and on the Internet as well as in group environments. This increases the amount of paperwork. And in most occasions their credentialing is related to Medicare and Medicaid which takes more time to verify them. The same consumes that time and increases the expense.

Therapists and Allied Health Professionals

Physical therapists, therapists, occupational therapists and speech therapists should also be credentialed. They normally take less time than doctors or psychologists. However, this too depends on how many insurance firms they wish to have a membership with. Moreover, in case they either change states or deal with children or special populations, they require additional measures.

They might be of lower cost by a type of provider credentialing, but it does not imply that it is less significant. Billing delays and denials can be avoided by getting credentialed properly the first time.

Specialist vs. Generalist Cost Comparison

The straightforward outlook can be given as follows: the specialists tend to pay higher prices than general providers. Why? The reason is that their histories are longer and detailed. There can be a general doctor working with five insurance companies. Ten might be the number of different people that a specialist would have to work with. The increase in applications implies the increase in hours thus the increase in fees.

Moreover, insurance companies tend to be more vigilant towards special services. It implies further questions, further correction, and further follow-up. Thus, the cost comparison between the specialist and the generalist is always resolved in the favor of the generalists regarding costs.

Factors That Cause Price Variations

You now have gotten the picture that provider type influences the price. Still, that is not everything. These are some additional reasons why cost of credentialing varies:

The place you are in counts. The providers in the urban setting might pay more due to high competition and paperwork is complicated. The rural providers can pay lower but it is not always the case.

It counts the number of states that you work in. The more the states, the more the checks of licenses.

The way you have set up your practice is important. Small individual providers are likely to pay a lower amount as compared to large clinics that have many providers.

It is important to consider the number of insurance panels. The greater the number of associations you can desire to be a part of, the more laborious it becomes.

The order of things means everything to you. Rush credentialing can get expensive in case you require it.

Choosing the Right Credentialing Partner

Also, you do not have to manage all this on your own. This is where Credex Healthcare is used. We simplify credentialing and make it correct the first time, secure and swift. We deal with doctors, nurse practitioners, behavioral, and health providers, and all in-between.

We provide transparent, out front pricing. We tell them what they need. And we do not leave you in the dark. No matter the extent of assistance required, be it on an individual panel basis or enrollment with a provider, we are at your disposal.

Conclusion

This is the reason why not all providers will charge the same cost of credentialing. The price of credentialing by provider type varies depending on your employment, your job history and your set up. Doctors, NPs, and therapists will experience varied rules, schedules, and documentation.

But there is one thing which remains unaltered namely; Credex Healthcare is your best partner. We are aware of what each type of provider requires. We save time. We eliminate stress. And we can make you get paid quicker.

FAQs:

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

Yes, doctors are normally more as its credentialing procedure requires more and longer. They tend to have a longer history of training, affiliation with hospitals, and accept more panel-insurances.

Q2: Why does specialty influence the fees of credentialing?

The high fees are more likely to be charged by specialists since they identify credentialing issues that pertain to more paper paperwork, additional verifications and rigid payer requirements. The greater complexity the more time and the more cost.

Q3: Do behavioral certifications have lower expenses?

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

Q4: Is it possible to negotiate credentialing fee?

Yes, particularly when dealing with a multi-provider credentialing or bundled services. We have tailor made plans that are suited to your needs and pocket at Credex Healthcare.

Q5: How is it least expensive to get credentialed?

When dealing with a credible credentialing partner such as Credex Healthcare, it saves on money in the long run. We prevent the time-wasting and refusals that will cost you even more in the future.