• When setting up a healthcare practice, provider credentialing is an inevitable process. Becoming a contracted provider with government agencies like Medicare, and any commercial insurance company is an essential way to obtain regular patient referrals. This is vital for cash flow. Avoid making the most common mistakes during the credentialing and provider enrollment process and you’ll experience much more ease and efficiency.

    Include Complete and Accurate Information

    One of the most frequently made mistakes the credentialing process is failure to simply fully complete the requested information. The initial application requests information such as provider name, clinic address, phone and fax numbers, as well as service provider type. Omitting any one of those items can result in a delay of processing your application. Worse, in some cases, you may receive denial into the network. Plus, forgetting to sign and date the application can cause significant delays in provider enrollment processing.

    Don’t Forget the CAQH Account

    As the world of technology evolves, so does the credentialing process. A recent evolution is CAQH, formerly the Universal Provider Datasource. CAQH is a database where insurance companies can go to obtain information needed to complete all that the credentialing process involves. It is becoming more common for commercial insurance companies to require providers to have a CAQH number. Go to the CAQH website to request an identification number, or if you are unsure if you already have one. Having this information updated initially, and regularly, will make the overall process much smoother.

    Don’t Start the Process Too Late

    Many insurance companies will not back-date effective dates on contracts. So, it is important to get the application process started sooner rather than later. The ideal time to start compiling your applications is 60-90 days prior to your clinic opening. Once you have the clinic’s pertinent information, (i.e.: lease, TIN number, NPI number, and phone number) you can usually begin the provider enrollment process. Please be aware that for a new start-up company, it generally takes longer to get credentialed than an established practice just looking to add a location or a therapist.

    Ask a Professional

    Avoiding the major mistakes above can make the long and grueling credentialing and enrollment process much less painful.  If you aren’t sure how to being the process, please ask a professional. We at Integra Rehab Solutions provide occupational and physical therapy credentialing service. You’ll want to find a specialist in your area of practice. The last thing you want to do is start your new business venture off on the wrong foot.