The Need For A Dependable Provider Credentialing And Enrollment Process
The credentialing process typically takes between 60 and 120 days, so it is important to plan ahead. During the credentialing process, a mistake can result in a delay, which requires that the process be repeated. Providers who are not properly credentialed or re-credentialed with their insurance carrier will not receive reimbursement from the insurer. The process can be complicated even further by the fact that you are required to follow up with insurance payers periodically to ensure providers are enrolled in network when enrollment is open.
Martin Jacob 
The credentialing process typically takes between 60 and 120 days, so it is important to plan ahead. During the credentialing process, a mistake can result in a delay, which requires that the process be repeated.
Providers who are not properly credentialed or re-credentialed with their insurance carrier will not receive reimbursement from the insurer. The process can be complicated even further by the fact that you are required to follow up with insurance payers periodically to ensure providers are enrolled in network when enrollment is open.
Credentialing is often referred to as being included on insurance panels. Security clearance can be a time-consuming and challenging process. There is no one-size-fits-all approach.
Most insurance payers have their own credentialing processes, although Medicare, DME (Durable Medical Equipment), and Medicaid may be credentialed via their respective web portals.
Many insurance companies also require re-certification every few years. Medicare requires re-validation every five years, DMEPOS suppliers re-validate every three years, and some states require Medicaid re-validation annually.
Explore how credentialing differs from enrollment, and learn what steps you need to take to ensure an efficient credentialing process.
At WWS, we understand that it’s not a win for us unless it’s a win-win for you.
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