New Practice FAQ:
The 5 W's of Credentialing

By Kelsey Oliveira

Credentialing allows medical practices to participate with insurance companies. To help assist you, we’ve compiled a list of frequently asked questions people typically have in the credentialing process:

Q: Who applies for credentialing?
A: Typically, this would be the office manager who completes the forms on behalf of the provider, or the provider themselves. They can also utilize a hired credentialing company.

Q: What is credentialing?
A: It is the process in which the provider participates with insurance companies to submit claims and receive payments.

Q: When should I begin the process?
A: They should begin this process as soon as their Tax ID and Group NPIs are assigned. Medicare payers typically take the longest, so it should be the first payer to start.

Q: Why do I need to be credentialed?
A: Providers could be faced with claim denials for being non-participating, or could be paid out of network, causing the patients to have larger out of pocket expenses.

Q: How long does it take?
A: Medicare payers take the longest, as the average time is 90 to 180 days. Medicaid payers take about 90 days. Other Blue Shield or Commercial payers typically take 45 to 90 days.

Visit Our Dedicated New Practice Page

Opening a new practice is a big undertaking; we collected useful information and a few key recommendations to help out as you embark on this journey. It can be helpful to establish a plan to execute your first steps in the proper sequence, once you know which tasks are prerequisites for others. This helps keep your startup on schedule and helps avoid costly delays. We hope the information we collected here can help you make key start up decisions with confidence and in a timely manner. Our team can help eliminate the headaches of opening a practice so you can enjoy the personal and professional satisfaction that comes with this exciting stage of your career.

Amazing Charts Medical Practice Consultants are here to help! Click here to visit our dedicated New Practice page for materials to assist you with what you should know and be aware of when opening your new practice. 

Kelsey Oliveira is a Marketing Specialist at Amazing Charts and joined the company in 2019. She enjoys providing useful content and resources to help independent practices thrive.