One of the most significant things that healthcare providers should do in order to receive payment per service rendered is that of getting credentialed with insurance companies. Credentialing assists both a solo practitioner and a provider who is running a multi-provider clinic in billing such payers as Medicare, Medicaid, and commercial insurers on a legal basis. However, of all the inquiries made by providers, one of the most asked is how much the credentialing services are charged?

Credentialing processes are usually outsourced to credentialing companies or specialists, who take the whole process, including document collection, payer follow-ups. The knowledge of the price range of these services will enable you to know how much to expect to pay, the probability of potential costs of some services, and where to get the services or how to do them on your own manually.

Why Credentialing Services?

Sometimes credentials are tedious and intricate. It is conducting complex applications, keeping a current profile in such systems as CAQH, the protection of your National Provider Identifier (NPI), and signing up in PECOS with Medicare and tracking up following up with commercial carriers such as Aetna, Cigna, and Blue Cross Blue Shield.

Contracting a credentialing firm is cost-effective because it saves time, minimizes mistakes, as well as accelerates payer enrollment. This is particularly useful to any provider who has just begun taking on a new practice or entering in a group or taking on new payers on the panel. To others, professional assistance is worth the price, considering that it is easy and precise.

Average Cost Ranges: Individual vs. Group Practices

The cost of credentialing services lies in the specifics between the number of providers and payment providers. Credentialing of an individual provider usually costs anywhere between 200 to 500 dollars per payer on average and this depends on complexity and service level. The per-payer cost decreases by a few credentialing agencies by providing multiple payers that are bundled with a discount rate.

Companies can provide volume-discount rates to group practices or clinics that have multiple providers. A clinic that credentials three or more providers and five or more payers can place a package deal of between 1,500 and 5,000 dollars. Other practices that adhere to fast-track or expedited credentialing could pay extra rush charges.

Factors That Influence Service Pricing

Credentialing needs and the charge of these services will vary depending on a number of factors. To start with, the size of the insurance panels you have desired to be in is a determining factor. The increase in payers implies more paperwork, more follow-ups, and more time.

Second, the complexity may be influenced by the type of provider and specialty. As an example, behavioral health providers have to be documented extensively and required forms that vary by state. There is also facility credentialing that may be required by the hospitals or by the large groups of practices so this increases the workload as well.

Third, the timing and the price may be influenced by which state you are practicing in. The speed of processing varies among some states whereby some states have quicker processing systems and some other states have licensure requirements or layers of verification that causes delay in time and effort.

Other matters affecting pricing are your turn around time requirement to be enrolled, re-credentialing requirements and assistance you may require to obtain items such as contracting, setting up your CAQH profile, getting an NPI and enrolling in Medicare PECOS.

DIY vs. Outsourced: Hidden Costs of Doing It Alone

Though carrying out your own credentialing may sound like a more cost-effective strategy, it could soon turn frustrating. Management of credentialing involves deadlines, tracking of payer portal, response to verification copy and rejection or delay requests. An attestation not signed or a partially filled form means weeks, indeed months, of lost billing.

Lost revenue is the dark side of the DIY credentialing. When you fail to enroll in time, you cannot bill the payers and receive reimbursements. Such down time is particularly costly to newly-opened practices or providers changing employers.

There is also the in-house credentialing which implies the sacrifice of staff time. When your office manager is running after CAQH attestations rather than serving the patients or billings, it is not productive. Although not in a direct way, time and energy consumed can be more costly in the end.

Value of Professional Services

The credentialing services provided by professionals assist providers to make fewer errors and credential themselves quicker. A credentialing specialist is not only able to navigate through the world of payers, follow up your applications, and stay in touch with the status of the documents. It results in faster approvals, reduced rejections, and faster cash flow.

Credentialing companies are also abreast with payer rule change, CMS rules, and CAQH changes. Their experience may assist you to prevent most frequent pitfalls, such as filing out-dated forms, failing to make a re-attestation, etc.

In new practices, outsourcing of credentialing can be expensive but worth it. It enables you to concentrate on the attention of your patients, advertising, or starting your own clinic while ignoring any bureaucratic issues.

How to Compare Pricing: Hourly vs. Flat Fee Model

Various pricing models are applied by credentialing companies. Others are a single price based on each payer like 200-400 per payer. Others work on an hourly basis usually that rate is about 50-100 dollars per hour depending on the complexity and seniority of the staff. The third alternative could be the monthly subscription price to maintain credentialing services especially in larger practices or billing companies.

As the company is compared with another, search the obvious service breakdowns. Does CAQH setup come with the price? NPI help? PECOS enrollment? Contract negotiation?

Inquire as well about guarantees. Credible credentialing companies can be offering a credentialing success guarantee or free follow-ups in the case an application is rejected because of their mistake.

Tips to Keep Costs Manageable

Preparation early enough will reduce your costs of credentialing. By the time of hiring a service, you must gather essential paperwork, such as your license, DEA registration, malpractice insurance, W-9, and CV. Ensure that you are up to date in terms of your NPI and CAQH profile.

Do not hesitate to respond to document requests. Rework because of work that has been delayed might mean extra charges.

There are credentialing businesses that allow multi-payer discounts, therefore, cluster your payers under the same batch. Others package credentialing with billing services, and they give a discount when you enroll in both.

Conclusion: Return on Investment and Next Steps

Credentialing services are apparently expensive; however, there is a high rate of return. According to proper credentialing, then your flow of revenue does not have a stop before you start. It shields your practice against denials, delays, and rejections with payers.

Credit verification time is saved, fewer errors occur and payments are received earlier by using a trusted credentialing provider. As a new provider in a new private practice or a clinic that is expanding to new payer networks, professional credentialing is a good investment.

Once you are prepared to take the turn, and you need assistance with credentialing, Credex Healthcare can be contacted as a credentialing provider of moderate cost, accurate, and prompt services to solo practitioners and large practices alike.

FAQs About Credentialing Service Costs

1. How much does credentialing cost for a single provider?
   The cost per payer between two providers costs an average of $200 to $500. This cost is based on how many payers there are, documents required and fast turnaround.
2. Are there recurring credentialing fees?
   Yes. The larger number of payers demand re-credentialing chemistry within 2 to 3 years. There are those services that bill higher in terms of a renewal fee whilst others incorporate it with long term contracts.
3. Do all credentialing companies charge the same?
   No. Prices may significantly differ depending on the experience, services to be provided, the geographical location and whether the agency charges on flat rates or hourly.
4. Can I negotiate credentialing costs?
   Sometimes. Agencies can provide discounts on bundled services or practices of many providers. Package pricing is worth a question.
5. How do I compare pricing models?
   Take a look at what each package offers; application submission, CAQH updates, payer follow-ups, and re-credentialing. Indefinitely, flat fees are predictable, whereas with regards to hourly billing, there is a tendency to increase due to delays.