What is the Process of Getting Credentialed with Medical Insurance Companies?

The process of provider enrollment can take a lot of time, but it’s the only way a healthcare provider organization can become an in-network provider and be paid by insurance companies. Requirements differ among payers, but there are three basic steps that can be taken to ensure there are no issues with cash flow or scheduling. This includes credentialing and it’s important to be prepared with an NPI number and full licensure in the state in which services are intended to be provided, submit a participation request to the health plan using their application process, and receipt of a reference number to check enrollment status. The second step is contracting with the insurance networks, followed by establishing a process for billing the health plan for services. Expect the entire process to take anywhere from 90 to 150 days.


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Post By Ken Shafton (2,204 Posts)