Here are a number of questions we often receive related to insurance credentialing, CAQH credentialing, Medicare enrollment and practice start-up services.
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.
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.
Here is the website for CAQH: https://upd.caqh.org/OAS/
CAQH Provider Help Desk:
888-599-1771
caqh.updhelp@acsgs.com
Help Desk Hours:
7am-9pm EST Monday – Thursday
7am-7pm EST Friday