Updated: Jul 8, 2020
Being highly successful in the field of optometry credentialing services for over 15 years, CS EYE has had the experience of solving the most complicated problems that our clients can have vis-à-vis credentialing. What do you think is the most common question asked by our clients? Can you guess what most of our clients are interested in knowing about credentialing?
It’s the length of the process and how long it takes before they are credentialed to serve on insurance panels and ready to offer their services to their patients. Among the many other complexities involved in the process of credentialing, the time consumed by the process remains the major concern for stakeholders, as it has a major impact on their organization’s profitability.
How Long does the Process of Credentialing Take and Why?
Based on our experience of offering credentialing services for more than a decade, we have found that the entire process of credentialing takes around 90-120 days, especially for those who are in rush.
Though this marks just an average timeline, the entire credentialing process may take longer or shorter for payers based on their specialties. So, it is highly important to understand various elements of credentialing to find out how long it will take for you to complete the process.
Steps Involved in the Process of Credentialing
1. Obtaining the Application
This is one of the most challenging tasks involved in the process of credentialing. The credentialing application is not only vast, with the total page count ranging between 3 to 3000, but obtaining it can also require a letter of interest in some cases. On verifying your National Provider Identifier (NPI) and Tax ID number with the database to identify whether you will be allowed to be a part of a credentialing network.
2. Completing the Application
While the process of obtaining a credentialing application is quite a tedious task, completing such a vast application is even more daunting. In order to answer all the standard questions asked in the application, you will require a series of documents such as degrees, various medical certificates, work history, documentation for ownership of your business, continuing medical education (CMEs) for physicians, and documents about other policies.
3. Submitting the Application
After completing and submitting the vast application of credentialing, another tedious task needs to be completed. Though providers assure you to process your application within 90-120 days, it becomes your responsibility to take timely follow-up of the process. A weekly follow-up is recommended so that you can catch errors at the right time and save time taken by the entire credentialing process.
4. Post-submission Formalities
After the submission of your application, the payor performs various processes to verify your profile and documents that you submitted. All the information is your application is first compared with your CAQH (Council for Affordable Quality Healthcare, Inc.) profile, and in case of any discrepancies, a delay in the process is inevitable. The status of all your licenses including from your Drug Enforcement Agency (DEA) and your medical licenses and everything in between.
After many more formalities such as these, you are notified of the acceptance of your credentialing application. Then you have to sign and return a contract offered by the payor, which is again, followed by a waiting time for receiving a notice from the payer on an effective date, and that your contract is uploaded to their system.