Credentialing Timeline

Becoming a credentialed provider is a lengthy and complicated process.The timeline to become credentialed can differ from payer topayer. When sending applications to become an in-network provider it’s good to keep in mind that as fast as you apply and submit the necessary paperwork there are internal processes that must take pace to credential you properly. Governmental insurance plans like Medicaid, Medicare & CHIP involve a more tedious process than commercial/private insurances like BCBS, Cigna & United Healthcare. This is due to the extra liability that governmental plans have regarding their patients. The verification of each provider and practice is thorough and extensive to make sure each provider the payer allows into the network is experienced and compliant.

Below is the average timeline and steps that are necessary to completely credential a provider in the payer’s network.

1. A provider interest form must be sent to the insurance provider.

  • You should receive a response from the insurance provider in 10-15 days saying they are or are not accepting new practitioners into their network, in that area, at that time.

2. If the network is open an application must be submitted.

  • A committee meets once per month, the day the committee meets differs from payer to payer.
  • If all documentation needed for the application are not present and submitted by that committee meeting date, your application will be pushed to the following committee meeting next month.
  • If everything is filed and submitted correctly, they will provide you with an answer in 30-45 days.

3. Application accepted or denied.

  • If accepted they will give you an activation date.
  • Example: Normally if the application is accepted July 1st, they would give an activation date sometime in August.
  • The process isn’t complete yet, even after the activation date has been assigned there is still internal filing that must be done to completely integrate the new provider in all the associated networks.

4. The internal filing process begins.

  • They file and send your information to all plans associated with that payer.
  • They alert their customer service department of a new provider so that when patients call, you are recognized as an in-network provider for covered services.
  • This process can take a while so even though you have an activation date it may take weeks for you to be completely integrated into their network and ready to see patients and bill services.
  • The internal filing process can take up to 90 days.

5. The entire credentialing process can take anywhere from 120-140 days to obtain your credentials and be entirely integrated in all the payer networks.

If you are facing any credentialing challenges or simply don’t have enough time in the day to get yourself credentialed properly, give us a call today to receive expert and dedicated support.

By: Riley Roberts, Healthcare Sales Representative