Can I Do My Own Credentialing?

The question that arises to many individual health practitioners and small practices is, are you able to credential yourself? Yes it is, but with some essential considerations. Well, credentialing involves the process of being authorized by the insurance credentialing process to practice on patients and be able to be paid. 

Some think that providers should employ the services of credentialing firms whereas some attempt to do it on their own. This blog at Credex healthcare discusses the appearance of DIY credentialing, its advantages and disadvantages, and situations under which outsourcing needs to be preferred.

Understanding the Credentialing Process

Credentialing is a comprehensive procedure. Insurance agencies would like to ensure that the healthcare companies are licensed, skilled and secure to their members. In order to be able to do this, they check your education, employment history, licenses and so on. You also have to join the system of each payer, like Medicare, Medicaid and the like. Here lets not forget the private insurers like Aetna or Blue Cross Blue Shield.

It begins by registering your National Provider Identifier (NPI) and a CAQH ProView profile. Then, you will need to approach every insurance credentialing process and submit necessary documents and undergo a background check. When it is approved then you are ready to start offering your services on a billing system.

DIY Credentialing: A Step-by-Step Journey

In case you consider doing it yourself, this is what it implies. The first step is to obtain your NPI number by visiting the National Plan and Provider Enumeration System (NPPES). Second, ensure the license of your profession is active and updated.

Afterward, sign up on CAQH ProView. Your credentials can be stored in this platform and payers can have an easy time reviewing your credentials. Once that is done, you should then apply to every insurance company one by one. This involves the completion of applications, submission of material such as your DEA registration and malpractice insurance, as well as signing contracts.

The majority of insurance companies regard examination of working experience and education as well. They can also make a call to people you have worked or studied before to confirm. This entire process may last as long as weeks and even months.

Pros and Cons of Doing Your Own Credentialing

It is true self credentialing saves you money. Credentialing is more cost effective when you do it on your own through self-credentialing. It is one of the major reasons why most solo providers and small clinics attempt it. This is one dollar in a new practice you can do without. You are fully in control of each step as well. You understand when to submit forms, what to send and how to react when an insurance company asks you a question. There are some providers gaining comfort about doing things the way they like and not having to depend on a third party.

The next benefit is that you acquire the knowledge of the entire credentialing process. This information can assist you to manage your practice better in future. You are aware of what each insurance credentialing process desires and you are able to effect them within a short time without necessarily waiting to be dealt with by somebody. DIY should be the choice in case you are an organized person and feel comfortable working with paperwork.

However, there is a dark side of the process. One, it is time consuming. You will waste hours of your life filling in applications, uploading documents and updating profiles and holding on the phone to insurance companies. Every payer possesses its regulations, documents and deadlines. The absence of one piece of information such as expired license or unsigned W-9 may halt all the proceedings. That translates to wasted time and potential loss of revenue in case you do not charge your patients a visitation fee.

Their mistakes are not difficult to say when one is not experienced. In case you do not remember to re-attest your CAQH setup for solo providers after 120 days, your file turns into inactive. That by itself can hold up your application weeks. There are also the rejection of applications because of the fact that not all the work histories are complete or that the background checks have not been made. The cost of repairing these problems later in time is even more time consuming.

There are times when the providers tend to be overwhelmed and quit halfway. This may postpone their capacity to attend to patients who are insured and this is detrimental to their bottom line. This is why even after jumping off as providers, the provider ends up hiring credentialing professionals to clean and finish up the process.

Common Pitfalls and How to Avoid Them

The typical error in DIY credentialing has been to leave your CAQH setup for solo providers unauthenticated or otherwise incomplete. This may prevent the progress of insurance companies. Now, another thing that you can forget is to bring all the necessary documents such as your license, malpractice policy or W-9.

Another issue that many of the providers overlook is re-attestation of the CAQH after every 120 days. Otherwise, without performing this step, your credentialing can be denied or delayed. To eliminate such problems, remember to have a checklist and calendar reminders.

Cost and Time: DIY vs Professional Services

Credentialing yourself is a service that does not cost money. But time may be a high price to pay. Credentialing is an average of 60 to 120 days. Any inability to work with that timeline can make that time frame even longer when you have not been educated in the process.

Credentialing firms generally ask from $200 to 250 per payer or a flat fee depending on assistance in full service. Although this is an expense, they have a habit of accelerating and decreasing error.. They also monitor credentialing and update everything.

When Outsourcing Makes More Sense

Outsourcing should be a more appropriate option when you plan to open a new practice and you need to treat patients immediately. It also comes in handy in those times when you do not need to take time learning every one of the payers procedures or need to avoid regularly following up. This answers the questions as how to get credentialed with payers?

Credentialing specialists are aware of how to handle every insurer even Medicare and state Medicaid insurances and can assist you to enroll quickly.

Another reason why providers prefer outsourcing is when rejected or lost money as a result of denied claims. It is true that credentialing services can minimize such risks by ensuring that your applications are incomplete and accurate.

Final Thoughts: Should You Do It Yourself?

Indeed you can perform your own credentialing but this requires time, concentration and structure. In case you are an individual provider who has some spare time, then the self-credentialing could help. You only need to be ready to learn all the process, meet deadlines, and make follow ups on each payer.

But in case you require an immediate effect and probable reduction of errors, more time to attend to your patients, you probably will think of employing a credentialing company, as it could pay off. Credentialing is something you cannot avoid at all whatever your decision to work alone or recruit the assistance of any person.

FAQs

1. Is self credentialing legal?

Yes, in some legal terms, healthcare providers are allowed to carry out their own credentialing. It has no rule that one has to recruit a company to do the same.

2. Am I going to have some money saved?

You will not pay any service fee but you might consume a lot of time. Mistakes and delays may be costly to you because you can fail to charge an insurance.

3. What is the tough road in DIY credentialing?

One of the most difficult tasks is maintaining and updating your CAQH profile and completing it. It can also be challenging to follow a unique procedure of each payer.

4. Can I change to a credentialing company in future?

Yes, a number of providers are self-initiated before contracting a company. You should know that it can be assumed by credentialing services, even if you already have started to process your applications.

5. Is it longer to do it myself?

Often, yes. Credentialing companies are familiar with the most effective methods of accelerating approval. Working by yourself without experimentation may bring you to a slow pace.