How long does it take to get credentialed with insurance companies and why?

The average time it takes for providers to get credentialed is between 90 to 120 days (and up to 180 days in some cases). Some insurance companies process applications faster, while others may take longer, especially for certain specialties.

So, the time frame varies significantly, depending on tons of factors. We’ll talk about them in detail as you scroll through.

The Timeline for Provider Credentialing Process

The credentialing process for healthcare providers with insurance companies involves several key steps, each taking a specific amount of time.

Here’s a detailed timeline breakdown of the credentialing process.

1. Preparing Documentation (1-2 Weeks)

The initial step involves collecting all necessary documents that may take 1-2 weeks. A credentialing specialist can review these documents thoroughly who also conducts primary source verification to ensure accuracy.

Providers should prepare a checklist to streamline this phase.

Application: General information including personal details, contact information, and professional background.

Education: Documentation of education such as diplomas, specialty certificates, and additional qualifications.

Licenses and Certifications: Copies of current and valid medical licenses, board certifications, and registrations.

Work History: Detailed account of previous positions, dates of employment, and responsibilities.

Malpractice Insurance: Proof of malpractice or liability insurance coverage.

References: Professional references from colleagues, supervisors, or mentors.

DEA Registration: Drug Enforcement Administration registration details for prescribing controlled substances.

Personal Identification: Valid identification documents like a driver’s license, passport, or social security number.

Background Check: Verification of criminal records and/or disciplinary actions.

Credential Evaluation: Assessment against the organization’s specific criteria.

Preparing and gathering necessary documentation helps streamline the credentialing process and avoid delays.

2. Submitting Applications (1-2 Weeks)

After gathering documents, providers fill out application forms for getting credentialed with insurance companies. This step includes gathering personal details, filling in required information, reviewing for accuracy, and submitting the applications. Generally, it takes 1-2 weeks, but using robust credentialing software speeds up the process.

• Get personal, professional, and supporting documents (1-2 Days).
• Fill out the application forms and start leveraging software (3-5 Days).
• Proofread and review the entire application once again (1-2 Days).
• Submit the application with methods specified by insurance companies (1-2 Days).
• Track submissions, respond to requests, and follow up with the insurance companies (ongoing).

Using the right tools and strategies helps you manage, complete and submit applications effectively within the 1-2 week timeframe.

3. Primary Source Verification (4-6 Weeks)

During this crucial phase, insurance companies verify credentials directly with educational institutions, licensing boards, and previous employers. This credentialing step ensures the accuracy and authenticity of the provider’s qualifications.

The time frame can vary depending on the responsiveness of the institutions and agencies involved. But generally, it takes around 4-6 weeks. You can do nothing about it, just make sure you give accurate information and truthful documentation.

4. Insurance Company Review (4-8 Weeks)

Once verification is complete, the insurance company reviews the application in detail. This includes checking compliance with their internal standards. The time frame is usually 4-8 weeks but can vary based on the thoroughness of their review process.

The insurance company reviews the application, assessing the provider’s qualifications, experience, and background. The process may include:

• Application Assessment
• Compliance Check
• Background Verification
• Internal Review Timelines

Delays can occur if the insurance company needs further clarification or if there are issues with the documentation provided. It can also take long if the insurance company’s internal review committees meet less frequently.

5. Board or Committee Approval (1-2 Weeks)

The application is then presented to a credentialing committee or board, which meets monthly or bi-monthly. It evaluates all findings and makes a decision on the provider’s credentialing status.

The timing of the next available meeting can influence how quickly the application is reviewed. But usually, this step in the provider credentialing process takes 1 to 2 weeks approximately. You cannot do anything to expedite the process.

The credentialing committee typically includes healthcare professionals and administrative staff, and it reviews the application in detail. They assess qualifications, experience, and findings from the background checks and compliance reviews.

After the committee review, the members raise concerns and talk about the provider’s suitability for inclusion in the network. And then, they vote on whether to approve, deny the application, or request some more information.

If approved, you’re done with the initial credentialing process and get in-network with the insurance. But if the additional information is required, the process gets extended until the next committee meeting.

6. Contracting and Enrollment (2-4 Weeks)

After approval, you as a healthcare provider will receive and review a contract outlining participation terms. You can negotiate before signing. Once signed, you are officially enrolled in the insurance network.

The insurance company updates their systems to include you as a new provider in their network. This ensures that patients and other stakeholders can see that the provider is now part of the network. The provider receives a notification confirming their enrollment.

This step in credentialing typically takes 2-4 weeks to complete, depending on the efficiency of both the provider and the insurance company.

In total, the entire credentialing process can take between 12 to 24 weeks (approximately 3 to 6 months), depending on these factors:

• The completeness of the application.
• The responsiveness of third-party verification sources.
• And internal processing times of the insurance company.

But why does the credentialing take ages? Let us answer that!

Why Does Provider Credentialing Take So Long?

As a healthcare provider, you’ve jumped through all the hoops – submitting your application, paying fees, providing documents – to get credentialed. But instead of the few weeks you expected, it’s been months, and your insurance credentialing status is still stuck in limbo. What gives?

You’re not the problem. The snail’s pace is by design on the insurers’ part.

Insurance companies follow a lengthy, rigorous credentialing process to vet every provider before allowing them to join their network. This involves verifying your qualifications, work history, malpractice coverage, and other aspects that affect your ability to deliver safe, quality care. They must comb through primary source verifications, license checks, and other certifications.

So while frustrating for providers, the long credentialing timeframe stems from the insurer’s due diligence. For you, it means playing the waiting game.

Here’s an overview of what contributes to these delays.

Extensive Verification

Credentialing requires thorough verification of a provider’s education, training, licenses, certifications, work history, and malpractice records. This process involves contacting multiple institutions, which can take time.

Primary Source Verification

Each piece of information must be confirmed directly with original sources, such as medical schools, licensing boards, and other institutions. This step ensures accuracy but lengthens the timeline of provider credentialing.

Background Checks

Comprehensive background checks, including criminal history and malpractice verification, are crucial for patient safety. These checks can take considerable time to complete, making sense of prolonged credentialing timeframe.

Committee Reviews

Credentialing committees need to review and approve applications. Delays can occur if there are scheduling conflicts or backlogs of applications in the review process.

Incomplete Applications

Missing or incorrect information in a provider’s application can cause significant delays. Requests for additional documentation or corrections can add weeks or even months.

Lack of Standardization

Different healthcare facilities may have varying requirements and processes for credentialing. There’s no standardization and this creates redundancy and inefficiencies, prolonging the process.

High Volume of Providers

When many providers are seeking credentialing at the same time, backlogs can develop, slowing down the overall process.

Response Times from Institutions

Delays can occur if educational institutions or previous employers take too long to respond to verification requests. A slow response can add weeks to the provider credentialing timeline.

Discrepancies in Documentation

Additional follow-ups are required if there are discrepancies in the information provided. Investigating these issues can significantly extend the credentialing process.

Scheduling Conflicts

If the credentialing board has a busy schedule, it may take longer to get applications reviewed and approved.

Internal Processing Delays

The insurance company or healthcare facility may have internal processing delays due to staffing, policy changes, or procedural bottlenecks.

Tips to Speed Up Insurance Credentialing Process

To expedite the credentialing process, providers must start the process earlier, use robust software, establish a clear workflow, set reminders for follow-up, and hire a good healthcare credentialing company.

Streamline Documentation

To speed up the insurance credentialing process, healthcare providers can follow these steps to improve how they handle and submit their application documents:

➜ Organize Your Documents: Create a list of all the documents you need, like insurance information, licenses, and certificates. Put them in a special folder so you can get to them easily.

➜ Use Standard forms: Submit documents in widely accepted formats (like PDF). This reduces confusion and makes it easier for insurance companies to review your materials.

➜ Double-Check Everything: Make sure all of your documents are complete and accurate before sending them in. Delays can happen when information is missing or wrong.

➜ Digital Submission: Whenever possible, submit applications and documents electronically. This speeds up the process and reduces the risk of lost paperwork.

➜ Follow Up: Once you’ve sent your documents to the insurance company, call them again to make sure they got them and to find out what’s going on with your application.

Conduct Pre-Credentialing Reviews

Conducting pre-credentialing reviews is an effective way to speed up the credentialing process. By taking proactive steps, you can ensure that everything is in order before submitting applications.

➜ Use Pre-Screening Checklists:

• Develop checklists that list all the necessary documents and information needed for credentialing.
• Check these lists to identify any missing items or potential issues before you submit the application.

➜ Hold Mock Credentialing Sessions:

• Conduct practice sessions that simulate the credentialing process.
• Use these sessions to spot any bottlenecks or problems that might slow down the process.

Engage a Credentialing Service

As a healthcare worker, you can get outside help to speed things up if you need to.

Using third-party companies that offer credentialing services is one strategy. These businesses already have systems in place and connections with payers that make the credentialing process go faster. As part of their routine work, they fill out forms, check papers, and follow up with insurance companies. Because of this, you will be able to focus more on each patient.

Working together with a Managed Service Organization (MSO) is another choice. MSOs offer full credentialing support as one of their many services. Some of the things they do to help you get accepted are talking to payers, filing claims, negotiating contracts, and managing the medical revenue cycle. This all-around service makes sure that your credentials are always up-to-date and that you get paid quickly for your claims.

Strengthen Relationships with Payers

Healthcare providers should focus on building better connections with payers to speed up the insurance credentialing process. This means keeping in regular contact with payer officials and quickly informing them about any changes that could affect credentialing.

Here are some key areas for providers to focus on:

• ➜ Talk Directly to Payer Staff: Reach out to the payer credentialing team. This can help clarify any confusing requirements and ensure you understand what’s needed. Having a specific contact person can also make it easier to check on the status of your applications and resolve any issues that might delay acceptance.
• ➜ Keep Payers Updated: It’s important to inform payers about any changes to your details. This includes updates to credentials, locations, affiliations, licenses, and more. By giving timely notice, payers can quickly update their records, which helps prevent administrative hiccups that could slow down the process.

By sharing clear information and delivering frequent updates, providers can groove their way to solid relationships with payers. This not only jazzes up the credentialing process but also lets providers get the green light faster, so they can jump right into caring for patients with insurance coverage.

Do you want to help more patients and make your treatment better? Insurance paneling can help you a lot! More people can use your health care services when you join well-known insurance companies via insurance paneling.

Are you not sure what to do with the process of medical insurance paneling? Remember not to worry!
We’re here to help you all the way through.

Get to know the people who are giving out credentials i.e. the credentialing panel. It tells you what to do and what paperwork is needed to verify your skills. It will also help you meet the standards if you know the paneling rules for each insurance company.

Follow these simple steps to learn about insurance panels and help your practice grow. Let’s start!

Get paneled with any insurance company of your choice!

Schedule Free Consultation

Understanding Insurance Paneling In Healthcare

An insurance panel refers to the list of healthcare providers that a health insurance payer (e.g. insurance company) has contracted with to provide medical services to its members at pre-negotiated rates. Joining an insurance panel means that a healthcare provider, such as a therapist, psychologist, or counselor, has entered into an agreement with a health insurance company to become an in-network provider for that insurer.

As an in-network provider, the healthcare professional agrees to the insurer’s contracted rates for services rendered to the insurance company’s members. In return, the provider gains access to the insurer’s covered patient population, with the advantage that patients face lower out-of-pocket costs for services from in-network providers compared to out-of-network providers.

Important terms related to insurance panels include in-network providers, who are healthcare professionals that have joined an insurer’s panel, and out-of-network providers, who have not contracted with a particular insurance company. Health insurance payers create provider networks by credentialing and contracting with providers who meet their criteria.

In contrast, providers who remain out-of-network do not join insurance panels. Out-of-network providers can set their own rates and are not bound to the terms and conditions set by insurers. They provide services to patients covered by that insurance, but the patient must pay upfront and submit claims themselves to seek reimbursement from their insurer at the out-of-network rate. Here the provider does not get paid directly by the insurer.

Step-by-Step Process for Getting Paneled with Insurance Companies

When you get paneled with an insurance company, you agree to work with them as a provider for a certain health insurance plan. After this insurance paneling, patients with a certain health insurance plan can come to your practice for care, and you can bill their insurance company for it.

Do not forget! Remember! Insurance companies only prefer paneling those healthcare providers who can help them manage healthcare costs. They are always on the lookout for medical service providers who will take less money. In contrast, health care workers want to work with insurance companies that will pay them more for their services. So finding the perfect insurance company to get paneled with becomes challenging for a doctor, but not impossible.

Here is a step-by-step guide on how to get paneled with insurance companies as a healthcare provider:

Step 1: Getting Your Documents Ready

Before applying to get paneled with insurance companies, you will require a lot of information and documentation. It is crucial to arrange these documents to avoid any kind of delay and denial in your application approval.

The documents are:  

• Licensure information
• Practice address
• NPI number
• Resume
• Proof of malpractice insurance
• Taxonomy code (if you plan to bill Medicare/Medicaid)
• Proof of liability insurance from your landlord (if you rent)
• Advanced training or credentialing paperwork (if you have any)

Step 2: Searching For Different Insurance Companies

Now as you have arranged all these documents, it’s time to look for different insurance companies. Keep in mind that each insurance company has its own rules and payment rates. Even some of the companies require years of experience before they’ll sign insurance paneling agreements with you.

Therefore, before you look for an insurance company, here are some important things to keep in mind:

Network Size — Look for insurers with large coverage networks in your geographic area to gain access to more potential patients. Larger insurers like UnitedHealthcare, Aetna, and Blue Cross Blue Shield often have expansive networks.

Reimbursement Rates — You should compare the rates that different insurers offer for the typical procedures you do. Higher rates mean more revenue per patient visit. Get the fee plans from each insurance company to help you decide which one to go with.

Experience Requirements — Some insurers require 1-2 years of practice experience before they will accept you as a provider. Therefore, when choosing an insurance company, you should look at these requirements and pick one without strict experience requirements.

Credentialing Timeline — Keep in mind that provider insurance paneling process could take 3 to 6 months. Therefore, we advise you to pick plans like Cigna and Humana that can get you credentialed faster so you can start sooner.

Payment Reliability — Make sure that insurance companies pay claims on time. You can find out about this by reading online reviews and asking coworkers about their own experiences. This step is very important because it will help you make steady money, which is important for any healthcare business.

Plan Types — Determine which types of plans are dominant in your area – PPOs, HMOs, EPOs, etc. After that, focus on insurance companies that offer those specific plans to get in touch with more patients in your target area.

Value-Based Care Initiatives — Check with each insurance company to see what role they play in value-based care models, such as responsible care organizations (ACOs) or patient-centered medical homes (PCMHs). These programs can change how care is given and how much is paid for it.

Administrative Support — Last but not least, look for insurance companies that offer helpful tools like online portals, electronic claims filing, and specific reps for providers. This help could make it a lot easier for your team in the administrative process.

In addition, applying to 3-5 insurance companies that align with your geographic location, specialties, experience level, and business needs can position your practice for success as an in-network provider.

Step 3: Submitting The Credentialing Application

Health care workers must send a separate application to each health insurance company they wish to work with in order to begin the provider credentialing and paneling process.

Now, here’s a handy tip: many insurance companies use the Council for Affordable Quality Healthcare (CAQH) for provider insurance paneling. The streamlined application system created by CAQH is called CAQH ProView, and it really helps providers get their credentials more quickly.

Once you’ve sent your application via CAQH, the insurance company you’re targeting will provide you with a unique application number. This number is quite useful because it allows you to see where your application stands in the credentialing process and helps you keep track of everything.

The CAQH ProView application serves as a centralized repository for your professional and practice information. This means you won’t have to submit separate applications to multiple insurance companies, which is a real time-saver. This feature reduces administrative burden and ensures consistency in the information you provide to payers.

Now, it’s very important to get the entry form right. Make sure to include all the necessary documents, such as your professional license, certifications, malpractice insurance, and details about your business. Paying close attention to every detail when you apply will help speed up the process.

Step 4: Following Up After Application

Once you send your insurance paneling application to the health insurance company, you should check back soon. Most insurance companies will give you an idea of how long it will take to get your credentials, which is generally between 4 and 6 weeks. Check in with the provider relations group again in 4 weeks to see how your application is going.

Make sure you have your NPI number, Tax ID number, and application reference number with you when you follow up. Make sure they got your complete application. This includes everything that is attached, like licenses, certificates, liability insurance, and a DEA certificate. Make sure that no more information is needed to finish the process of getting credentialed as an in-network provider.

If the application is still being worked on, follow up again in 6 weeks. Always following up in a professional way lets them know that you want to be a part of their network.

If your application is turned down, request the reasons in writing. Not having enough malpractice insurance or not being eligible for Medicare are some common reasons for rejection. Fix any issues and try again.

In your subsequent application, mention improvements like extended hours, bilingual staff, EMR systems, or new services offered. Joining provider panels can take persistence through multiple application cycles.

You can finish the process quickly if you keep checking on your credentialing application. Checking status routinely demonstrates your commitment to the insurer’s network and patients.

Step 5: Reviewing The Terms of Approval

Once insurance companies agree to let you join their network of providers, it’s important to read the terms and conditions carefully before signing any contracts. This will help keep problems from happening in the future.

Key things to look over:

Reimbursement Rates — Look over the fee schedules for your specialty to make sure the rates of reimbursement are fair. Keep a close eye on the relative value units (RVUs) that go with the CPT codes you bill most often.

Billing and Coding — Make sure you can meet all the standards for billing and coding. You should know what variations, CPT codes, and ICD diagnostic codes are accepted. Also, look over how to submit claims, when they need to be sent, and whether electronic or paper claims should be used.

Authorization Requirements — Write down any permissions, referrals, or other paperwork that you need to get before you can perform certain medical services or procedures.

Contract Exclusions — Look out for exclusions for medical services, procedures, diagnoses, or types of providers that you might want to offer.

Appeals Process — Understand the process and timeframes for claim appeals and denials.

Penalties — Carefully review any fines, fees that need to be paid back, or other punishments for not following medical billing rules or other terms.

Provider Portal Access — Make sure you can get to the portals that let you check on things like a patient’s eligibility, the state of their claims, the authorization requirements, and more.

Checking the contract terms carefully before signing will help you avoid problems and make sure the process goes smoothly with the payer. Use the network contract checklist and also have a lawyer look it over.

Some Important Tips

Here are some important things to keep in mind that could make it easy for you to get on the insurance companies’ lists and keep you out of trouble.

Get Board Certification

Getting board certification is an important step you don’t want to skip if you want to be accepted by big health insurance companies. This license is very important because it shows that you’ve been trained and tested very carefully in your field. It’s all about showing that you meet the high standards of ethics and practice that insurers want to see.

Most big insurance companies need this license to make sure that the doctors in their network are providing good care. So, when you’re done with your residency, you can choose to take an exam in your field, whether it’s internal medicine, pediatrics, or something else. Passing that test shows that you know what you’re talking about and are dedicated to keeping updated in your field.

Certain smaller insurers might not need board qualification right away, but having it makes you much more competitive. It’s a great way to show that you are committed to giving excellent care that is based on convincing evidence. So, you should definitely think about it!

Consider Intern Policy

When working with insurance companies as a healthcare provider, it is important to carefully consider your intern policies. Unlicensed interns, even if they have finished their degrees, are often not credentialed to bill for services on their own. In some states, Medicare and Medicaid let billing happen under a supervisor. But in other situations, this might be considered insurance fraud. To prevent problems, look up the laws in your state and understand the insurance policies for interns from each insurance company. If you check the rules carefully at the start, you can feel sure about making internship opportunities that follow billing regulations.

Know The Required Time

When you apply to work with insurance companies, it is important to know how long they take to review and approve your application. Every carrier has its own rules about how long the vetting process will take. Check how long it usually takes to get things done. This will help you know what to expect. Knowing the needed time helps you check in at the right times. During the paneling process, there are often many requests back and forth. It is important to keep track of response times to avoid delays on your side. Following the insurer’s schedule shows your professionalism and dedication to building the partnership.

Remember Previous Disciplinary Action (if any)

When you apply to get paneled with insurance companies, it is very important to be honest about any past disciplinary actions against you. Having a record of discipline does not mean you will be disqualified. However, if you do not tell about it, it can hurt your trustworthiness and slow down the approval process. Insurance companies will check your background very carefully, so being honest is always the best choice. Explain what happened with the discipline and highlight the good actions you have taken since that time. Showing that you have grown and take responsibility can help reduce worries. If you are honest and clear, you can still be accepted even if you had a past issue.

Know If You Are A New Licensee

Some insurance payers like to choose providers who have many years of experience before bringing them on board. As a new licensee, find insurance companies that accept new practitioners. You might also think about starting with Medicaid or Medicare if your state permits new providers. Build up your patient roster and get that initial experience. In one or two years, you will be better able to meet stricter requirements from commercial insurers. Do your homework first. This way, you won’t waste time applying to panels that will not accept you.

Stay Informed

For healthcare workers, getting on the panels of insurance companies is a big deal, but it’s only the start. Learn the most recent rules and guidelines from these insurance groups. This is the most important thing you can do to keep a friendship going on with them.

Insurance firms are very active and often change their rules to keep costs low and help people get good care. Stay alert and watch for these changes. It will be simple to make your business fit what they want. Through trust and following through, this builds a strong connection that lasts. It also makes sure that you can keep your services running. Be ready to learn something new all the time. Read insurance company papers, go to their seminars, and communicate with the relevant people in your field every day.

Benefits Of Getting Paneled With Insurance Companies

Getting paneled with insurance companies brings many benefits to healthcare providers. The most notable of them is that it opens windows to new opportunities, and assists you to grow footfalls of patients to your practice.

It Gets You More Patients.

When you join a lot of different insurance networks, you can get more patients who can use their plans to find your healthcare office and get care services.

It Boosts Your Chances Of Making Money.

More people will be able to get medical care from you if you are on the panels of more insurance companies. With this, you may be able to potentially make more money.

It Makes It Easier For People To Get Multiple Care Services.

You can make it easier for people to get a variety of low-cost medical services. People who really need care but can’t pay for it will benefit from this.

It Improves Your Professional Image.

One way to boost your credibility as an insurance agent is to be in network with respectable firms. This proves that your schooling, experience, and license are at the very best level required by these insurance companies.

Still Doing Credentialing Yourself? Stop the Madness!

Credentialing is a beast. It’s time to stop the do-it-yourself madness!

Our medical credentialing service empower you to see patients months sooner than doing it yourself.

No more staying late or working weekends on credentialing. Outsource to us and take back your evenings and weekends!

Schedule Free Consultation

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Assisting with billing, credentialing and enrollment, BellMedEx has been consistently reliable from the first day of our relationship.

Dr. Mike

Internal Specialist Medicine

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