Common Confusions With Credentialing

Common Confusions with Credentialing

What you need to know before opening your own practice

Opening your own practice is an exciting step for any medical professional. However, there are many things to consider before you can start seeing patients, and credentialing is one of the most important.

Credentialing is the process by which insurance companies verify that you are qualified to provide care to their beneficiaries. It can be a confusing process, and there are many common misconceptions that can lead to delays and problems.

In this blog post, we will discuss the three most common confusions with credentialing:

1. Disassociating yourself from former employers or groups:

If you are coming from a group practice, it is important to make sure that you are disassociated from them before you start credentialing for your own practice. This means that you need to contact all of the payers that you were contracted with at your old group and let them know that you are no longer affiliated with them. You will also need to provide them with your new tax ID number and NPI number.

1. The difference between credentialing and contracting:

Credentialing and contracting are two separate processes. Credentialing is the process by which insurance companies verify that you are qualified to provide care. Contracting is the process by which you agree to the terms and conditions of the insurance company's network. It is important to complete credentialing before you start contracting.

1. The effective date of your contract:

The effective date of your contract is the date on which your insurance contracts go into effect. This is not always the same date as the date you sign the contract. It is important to pay attention to the effective date of your contract, as any patients you see before that date will be considered out-of-network.

Here are some additional tips for avoiding credentialing problems:

• Start the credentialing process early. It can take up to 90 days to complete credentialing, so it is important to start early to avoid delays.
• Be prepared to provide all of the required documentation. The credentialing process requires a lot of documentation, so be sure to gather everything you need before you start.
• Ask questions. If you are unsure about anything, don't hesitate to ask your credentialing service or the insurance company for clarification.
• Follow up regularly. It is important to follow up with the insurance companies regularly to make sure that your credentialing application is moving forward.

By following these tips, you can avoid common credentialing problems and ensure a smooth transition to your own practice.

I hope this blog post has been helpful. If you have any questions, please leave them in the comments below.