How to Speed Up the Credentialing Process | Provider Enrollment Tips

In the U.S. healthcare industry, time matters more than anything else. If you’re a solo practitioner, part of a large medical group, or a telehealth provider expanding your services into new states, credentialing is crucial. Delays in credentialing can directly affect your revenue stream, patient care, and compliance. The credentialing procedure usually takes between 90 and 120 days. It can take longer if there are mistakes or missing documentation. Fortunately, there are proven methods to expedite and streamline the provider credentialing process.

This blog is all about “How to Speed Up the Credentialing Process | Provider Enrollment Tips,” and it will help you get faster medical credentialing. 

Why Faster Medical Credentialing Matters

For healthcare practitioners, credentialing time is crucial because each day a provider waits to receive their credentials is a day of lost revenue. When the credentialing process takes too long, the average doctor loses between $8,000 and $10,000 per month. For specialty groups, this number can be much higher. Delays not only affect you financially, but they also impact your ability to serve patients who need your care and can disrupt your practice’s progress.

Common Causes of Credentialing Delays

Understanding the factors that cause credentialing delays is the first step to avoiding these problems:

• Incomplete Documentation: Missing signatures, expired certificates, or blurry photos are the primary reasons for delays. Insurance companies will reject incomplete applications without review.
• Outdated Information: If you provide outdated addresses, phone numbers, or job histories, it can cause delays and denials. Payers have to verify all the information, and if it is outdated, it might take weeks.
• Poor Communication: You must be prompt in communicating with payers. If you respond promptly to the payer’s requests for further information, it would help prevent the entire review process from having to restart.
• Peak Season Bottlenecks: Applications submitted during busy months, such as January, when many companies update their panels, take longer to process.
• State-Specific Requirements: Every state has its own unique credentialing requirements, and most practitioners don’t know them or overlook them. This can cause delays. 

Speed Up the Credentialing Process | Provider Enrollment Tips

Many proven strategies can help you speed up the credentialing process. If you deal with delaying issues early on, you won’t have to wait long for your credentials, and your onboarding timetable will stay on track.

Organize Documentation Early

The first and foremost step to avoid credentialing delays is to organize your documentation early, before you submit your first application. Create a comprehensive file of documents that includes:

• Updated CV or resume
• State-issued medical licenses
• DEA and CDS Forms
• Board Certifications
• Malpractice Insurance
• Work history and references

If you keep these documents organized, you won’t waste weeks searching for missing information.

Pro Tip: Save all of your files as PDFs after performing a high-quality scan. Place both hard and soft copies in folders that are labeled clearly to keep them organized.

Keep CAQH Profile Updated

The Council for Affordable Quality Healthcare (CAQH) database is where most payers check provider information. If your CAQH page is incomplete or outdated, you may not be eligible to apply. You should go back and re-attest your CAQH profile every 120 days. This will streamline provider credentialing and reduce unnecessary delays.

• Complete Every Section: Do not leave any fields blank. If you don’t have to do something, don’t leave it blank; instead, write “N/A.”
• Update Immediately: You have 30 days to log in to CAQH and modify your information if you relocate, change your phone number, renew your license, or obtain new insurance.
• Attest Quarterly: This means you need to check that your information is still valid. Add this day to your calendar so you don’t forget it.
• Uploading Supporting Documents: Don’t just fill in information; offer the licenses and certificates that prove what you’re stating.

Leverage Credentialing Software or Services

Modern, efficient credentialing solutions can save a significant amount of time by automating and streamlining tasks. 

• Application Management: With software, you may fill out applications with information you’ve already saved. It reduces errors and ensures consistency across multiple applications.
• Keeping Track of Deadlines: Automatic reminders help you respond swiftly to requests from payers and keep an eye on the status of more than one insurance application.
• Managing Documents: By keeping all your files in one location and setting notifications for when they expire, you can be sure that you are always dealing with the most recent files.
• Status Updates: With real-time tracking, you can always see where each entry is in the review process.

Respond Promptly to Payer Requests

You normally have 30 days to respond when insurance companies ask for more information. But if you respond within 5 to 7 business days, it can accelerate the credentialing process.

• Check Communication Daily: Monitor your email, mail, and internet portals to see if payers have contacted you. Each request has its own due date.
• Provide Requested Documents and Information: Don’t send extra information that wasn’t asked for; instead, ensure that you provide exactly what was asked for in the way it was asked.
• Follow Up: After you send in further information, call or email to make sure they got it and to find out what happens next.
• Keep Records: For every discussion you have with payers, write down the date, the names of the people you talked to, and the reference number.

Use Pre-Application Checklists:

A pre-application checklist can help you gather all the necessary information and documents before submitting your application. If you do this simple thing, you can avoid credentialing delays and unnecessary extra work. Different insurance companies have varying standards, but having standard plans helps ensure that nothing is overlooked.

The Basic Requirements Checklist Includes:

• Current medical license with at least six months’ expiry.
• Current DEA certificate and not near expiration.
• Malpractice insurance that meets the minimum coverage requirements.
• Board certification (if necessary).
• Completed the application with all the signatures.
• Updated and attested CAQH profile within 120 days.

Consider Outsourcing to Professionals:

Many practices find that using quick credentialing services or professional credentialing experts is the best way to expedite the credentialing process for providers.

When to Consider Outsourcing:

• You should outsource the credentialing process if:
• You need to get credentials from more than five different insurance providers.
• Your practice is expanding rapidly.
• You want to enter new states.
• Your staff doesn’t know how to handle credentials.
• You’ve experienced delays and denials with previous applications.

Benefits of Choosing Professional Credentialing Services:

• Knowledge of each payer’s requirements.
• Established connections with insurance firms.
• A specialized team will follow up on applications that are late.
• Check for errors and ensure quality standards are met.
• Issues are resolved more quickly as they arise.

How to Choose the Right Credentialing Partner?

Look for credentialing firms that have an excellent track record, transparent prices, and dedicated account management. Request examples of similar practices and determine the typical time it takes for them to issue credentials.

Benefits of Faster Medical Credentialing—Revenues, Patients, Compliance

If your practice doesn’t have the time or money to do it, it might be a brilliant idea to hire a credentialing company to do it for you. Companies that offer quick provider credentialing services already know what insurance companies want. They know about the common mistakes that cause delays and how to communicate with them. It needs investment, but it saves time and prevents delays from incurring significant expenses. There are many advantages of faster medical credentialing.

• Immediate Revenue Generation:

Fast credentialing has the benefit of allowing you to start generating revenue immediately. A family practice doctor normally makes between $15,000 and $20,000 a month; therefore, it’s really vital to be quick.

• Patient Access:

Patients can use your services more quickly if you obtain their permission more efficiently. This is excellent for the health of the community and makes patients happier.

• Competitive Advantage:

Securing your credentials promptly can help you gain a competitive edge in the market.

• Practice Growth:

Quick credentialing helps your practice grow by enabling it to enter new markets and service lines more quickly.

• Reduced Administration Burdens:

If your credentialing process works smoothly, your team can spend more time caring for patients and less time dealing with paperwork.

• Compliance Confidence:

If you have the necessary credentials, you can be assured that you’re following the law.

Conclusion—Speed Up With the Expert Credentialing Partners

Getting credentials doesn’t have to take a long time. If you arrange your files, keep your CAQH up to date, use technology, and hire a professional if needed, you can speed up the credentialing process and start assisting patients and billing payers sooner.

Always remember that planning and sticking to it are essential. Start organizing your papers early, keep your CAQH profile up to date, and don’t be hesitant to consult a professional for help if your team can’t handle the job.

Do you want to speed up your credentialing process? Contact our staff immediately for fast and efficient credentialing services that will save you time and worry.

FAQs

1: How long does the credentialing process usually take?

Credentialing normally takes 90 to 120 days, but the length of time can fluctuate depending on the provider and the state.

2: Can credentialing be fast-tracked?

Some payers do provide faster options, and employing professionals can also save time.

3: What documents should I prepare in advance?

You will require a current CV, licenses, DEA certifications, medical insurance, and a list of positions you’ve had.

4: Should I outsource credentialing to save time?

Yes, hiring can help you avoid mistakes, speed up the approval process, and cut down on wait times.