We spend a significant amount of time advising our clients on how to navigate the credentialing process. I wanted to compile a list of questions that i often get from providers.

Q: How long does the credentialing process take?

A: The length of time it takes for a provider varies by insurance company. On average most private insurance companies such as BCBS and Cigna take around 90 business days while government payors such as Tricare and Medicaid can take longer.  It is important to note that your credentialing company cannot influence this time in any way. Don’t let any company convince you otherwise.

Q: Do I have to have a physical office space in order to start the credentialing process?

A: Most insurance companies do not require you to have a physical “traditional “ office space in order to start the credentialing process.  There are some payors such as AETNA and Medicare (in most cases) require providers to have a physical office space.  

Q: But What if I am Telehealth only? Do I still need a space?
A: How you deliver your therapy is up to you, but most insurance companies will still require that you provide them a physical address. If this address is your home, you may opt to not show in the provider directory for privacy.

Q: I am credentialed at my group practice don’t I simply need to add a new location for my new practice? Shouldn’t the process be quicker?

A: No; When starting a private practice you will also need to go through the Contracting Stage in addition to the credentialing stage. During the contracting stage, a legal business relationship is established between your practice and the insurance company. This process in conjunction with the credentialing process can take a significant amount of time.

Q: My practice employs provisional/associate licensed professionals do I need to get them credentialed?

A: Yes and NO. Most Private/Commercial insurance companies do not credential associate licensed professionals nor do they support incident to billing. There are many state Medicaid Plans that have formal credentialing processes for associate licensed professionals.

Q: How Long is my Credentialing Valid? Do I have to renew every year?

A: After your initial credentialing is completed , providers are required to re-credential every two to three years.

Q: What about my provider contract ? Do I need to renew every year?

A: Your provider contract will remain in effect and automatically renew according to the terms of the agreement.

Q: I have submitted my credentialing application can I start seeing patients?

A: NO. You must wait until your credentialing is complete and your contract is counter executed by the insurance company with an effective date prior to seeing patients.

Q: Can I back bill for clients/patients seen once my credentialing is complete?

A: No. You must wait until your credentialing is complete and your contract is counter executed by the insurance company with an effective date. Any visits prior to the effective date will be processed as out of network by the insurance company. The exception to this rule is Medicare and some state Medicaid programs. Medicare will backdate the effective date of your credentialing to a month or two prior to the date you submitted your application. Some state Medicaid programs will allow you to choose your effective date up to one year prior to you submitting your application. Please check with your local state Medicaid program on their specific guidelines regarding effective dates.

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