Is DIY Credentialing Worth It?

Credentialing with insurance providers is a big step for healthcare providers. It is a process to be completed by a single physician or therapist as well as by a nurse practitioner that decides to open his practice on his own, in order to see insured patients and get payment. Credentialing is costly as well as time-consuming. 

This is why most of the providers wonder a lot, should I do it by myself? Or get an expert company?

This blog will assist you in making the decision. We are going to discuss what DIY credentialing is, its advantages and drawbacks, duration and when it is a good idea. This will help you understand whether it is worth doing it by yourself or just pay someone to do it.

What Is DIY Credentialing?

DIY credentialing implies that you or a person on your team does the whole credentialing by yourself. You do not employ a credentialing agency or third party provider. Rather, you do all the forms filling, document collection, and payer interaction on your own.

The process usually involves establishing or updating a CAQH ProView profile, PECOS application process to Medicare, enrollment in Medicaid, an individual insurance payer applications, and follow-up requests, etc. It also has such additional features as meeting the deadlines, monitoring re-credentialing and solving any complications that appear in the way.

The Advantages of DIY Credentialing

Cost saving is actually one of the greatest motivations of providers to do their own credentialing. In cases where you have only a small amount of money to spend on the startup process, you can deal with credentialing by yourself, which will allow you to save the money that you could have spent on a professional.

It also implies that you are in control when you do it yourself. You will know the exact documents that were filed, when follow ups should be done as well as know the status. In the long term, you can also develop a greater insight into the working process of credentialing, which will facilitate compliance and subsequent enrollments in the future.

The Disadvantages of DIY Credentialing

DIY credentialing does not cost much but is burdensome on time. All the insurance payers involve varied forms, regulations, and schedules. The paperwork becomes a headache to many of the healthcare providers and the procedures vague. Incidents such as missing documentation or obsolete CAQH profiles are quite enough to be described as a delay or denial.

It is also frustrating to follow up with various insurance companies. There is also pressure of re-credentialing on every anniversary. Failing to abide by them may lead to you being kicked out of a panel and losing money.

How Much Time Does DIY Credentialing Take?

Generally, it is 15 to 30 h per insurance company on average. That consists of doing a CAQH profile, collecting credentials, applying in PECOS (which is when you are enrolling in Medicare) and filling all forms with the privates, such as Aetna, Cigna or UnitedHealthcare.

That does not count the waiting time and error correction. This time requirement may be too much to handle by busy providers, especially those with patients or those operating a clinic.

When DIY Credentialing Makes Sense

Self credentialing can work when you enroll with one or two insurance panels. It can also suit you well in case you are already familiar with either billing or administrative fields. When you have a small practice and a limited number of personnel or a tight budget, credentialing may be the best solution that you can do by yourself.

DIY credentialing is also a reasonable option when you have time on your hands and are not in a rush to do things as you become a victim of working against lots of deadlines and numerous follow-ups during a period of several months.

When You Should Consider Credentialing Services

In case you are credentialing with multiple payers concurrently, you are multistate, or you need to be added to an insurance panel fast, it is more frequently to your advantage to employ a credentialing service. This is, however, more so applicable in mental health clinics, specialty practices, or providers with large patient populations.

Credentialing companies are already aware of the process of every payer. They minimize mistakes, do follow ups, and fill forms quicker. This leaves you free time to concentrate on developing your practice and attending to the patients, and leaves the paper work to be dealt with by the professionals.

DIY vs. Hiring a Credentialing Company

The main distinction between DIY and professional services is price. You go down that road and so long as it works, it is technically free but it costs you all kinds of time and effort. The most credentialing services range between 200 and 800 dollars per payer. That price amounts to completion of form, tracking and follow up of documents.

Your chance of rejection is also lowered by professionals. You may not know all the details, but credentialing agencies understand what payers require and how to deal with the mistakes. They also maintain re-credentialing dates hence you may not be noncompliant in the long run.

Tips for Providers Who Want to Try DIY Credentialing

In case you have an urge of credentialing yourself, be organized. Place a digital file of your license, malpractice insurance, resume, NPI, DEA registration, and other necessary documents. Keep your CAQH profile updated on a regular basis and be certain that you attest every 120 days.

I should keep a spreadsheet or calendar of the deadlines of each of the payers. When a form is rejected or sent back, repair it immediately. Ensure that you set reminders of re-credentialing and any renewals that can impact your applications.

Final Thoughts: Is DIY Credentialing Worth It?

The worth of DIY credentialing depends on your practice, whether it is worth it or not. It can be an intelligent cost-saving move when you sign up with a small number of payers, are free of time, and do not mind paperwork. However, in the case of growing practices (and individuals who find that they do not have time to spare), a quick setting, in a hurry, or those who provide their services in more than one state, then the credentialing agency will save time, decrease stress, and secure your revenue.

FAQs About DIY Credentialing

1. What is DIY credentialing?

DIY credentialing,  this is where a practitioner takes the insurance panel enrollment process into his own hands without hiring a credentialing firm.

2. How long does credentialing take if I do it myself?

The time varies between 60 and 180 days per payer depending on the accuracy and to the process of the insurance company.

3. Is it cheaper to do credentialing on my own?

Yes, it is not money you are paying to get a service, but it does take time: 15 to 30 hours per payer is not uncommon.

4. What are the risks of DIY credentialing?

These risks are application errors, delays, rejections and missing re-credentialing dates.

5. What tools or resources do I need for DIY credentialing?

You will require the use of CAQH ProView, PECOS (in the case of Medicare), payer applications and document secure file system and a deadline tracking mechanism.