FREQUENTLY ASKED QUESTIONS
Here are a number of questions we often receive related to insurance credentialing, CAQH credentialing, Medicare enrollment and practice start-up services.
Insurance credentialing and contracting fluctuates based on the area of the country and the provider’s unique situation. On average, it takes 120 days to become in-network with your major carriers. Credentialing takes about 60-90 days and contracting takes another 30-60 days depending on the carrier.
Yes, it’s often a point of frustration for providers to learn that they will need to complete credentialing and contracting for their new company even if they are currently credentialed under another local group. If in private practice(in the same area), it’s likely that your credentialing timeframe will be expedited but you will still need to have your organization fully contracted with the payers and your personal enrollment record will need to be linked to the new agreements. Total time if working in the same area under another practice is approximately 100 days. If working for a hospital or fresh out of training, you should give yourself an additional 60-90 days to get the process completed.
Credentialing and enrollment services are used interchangeably these days so it can be confusing. PES does provide both enrollment and credentialing services. Credentialing is used most of the time when referencing primary source verification which is something we perform for health plans and larger organizations.
Unfortunately, it’s rare to receive a retroactive effective date for commercial carriers. It’s best to assume that you will not receive a retro effective date which is why you need to start early and have a competent team handle the process.
Medicare enrollment can take up to 180 days but our average is around 55 days depending on what we are doing. Reassignment applications for an enrolled provider take about 40 days.
Yes, you can hold claims for Medicare and submit once you receive your Medicare PTAN and are successfully linked to the group. This can only happen if the application is submitted correctly and isn’t returned. If returned, the enrollment process starts over again. You cannot submit your application prior to 30 days before you plan to start seeing patients.
CAQH stands for “The Council for Affordable Quality Healthcare, Inc.”, a not-for-profit collaborative alliance of the nation’s leading health plans and networks.
Part of the CAQH’s credentialing database project is the new “Universal Credentialing DataSource.” This online database collects all provider information necessary for credentialing, and pulls it together into one database, which is then accessible to the different insurance carriers.
Use our Service as we are as fast as they come. 2 Days is our average and the average for a provider will be 3-4 weeks.
Yes. Most major insurance companies now require CAQH credentialing as the first step in the insurance enrollment process.
CAQH charges the insurance companies and is free for medical providers. We are a service that helps expedite the process.
CAQH numbers are only available to individual providers. Your organization will need a type II NPI but not a CAQH ID.
CAQH is simply where the insurance companies obtain their information. You will still need to contact the insurance companies and go through their internal credentialing and contracting process which can take an additional 90-120 days on average.