Credentialing FAQ

For many healthcare practices, credentialing can be both confusing and overwhelming.

At Acier Healthcare Business Solutions, we provide a full-service credentialing solution. Let us handle the complicated processes and the repeated follow up calls with insurance companies for you.

Listed below are answers to some of the most frequently asked questions about the credentialing process. Take some time and review the information below or simply call us at (855) 664-5154 with your questions, and we’ll be happy to help!

Q: Why would someone want or need credentialing?

Being credentialed with insurance panels means that you are able to see patients who have specific insurance plans and bill those insurance companies directly for the services you render. This can greatly increase the number of patients who can access your services.

Q: What is the process of getting credentialed with insurance companies?

When you decide to sign up with us, we will send you one simple application - we call it the master survey. This survey asks basic questions ranging from your license number to your educational history. Together, we decide what insurance companies you want to work with based on your license type and your practice location. Then our staff will begin the process of retrieving, completing, submitting, and following up on applications on your behalf. We keep in touch with you throughout the process and contact you if we ever need any additional information. If you ever want to check in on your progress you can call your Credentialing Specialist or view your Panel Details Summary in your online portal. Learn more about our process here!

Q: Do I get to choose the panels I want to be on?

Yes. When you sign up for credentialing with us, you get to choose exactly which panels you want, and don’t want, to be credentialed with.

Q: How can I track my insurance credentialing progress?

We provide client access to an online portal where you can always check the status of your project.  In addition, your Credentialing Specialist will reach out at regular scheduled intervals to provide personalized updates.  

Q: What if I don’t know which panels in my area are best for me?

We can help! One of our credentialing specialists will talk with you by phone and can help you to select the panels in your area that will be the best fit for you and your practice.

Q: What are some of the more popular insurance companies?

The popularity of insurance companies varies depending on location. However, some of the most popular and largest insurance companies are Aetna, Cigna, Magellan, Tricare, United Healthcare, Humana, Value Options/Beacon Health Options, Medicare, and many others.

Q: How long does the credentialing process take?

The credentialing process generally takes between 90-120 days. When you sign up for credentialing with us, we waste no time getting your applications completed and submitted to insurance companies. We then follow up proactively with insurance companies to make sure that your credentialing applications are processed and approved as soon as possible.

Q: How many hours of work does insurance credentialing take?

The amount of time that it takes to complete the credentialing process varies by license type.  For a standard outpatient practice, the Credentialing Team will put in between 10 and 12 hours of work for each insurance panel.  If an appeal has to be filed, that will add a minimum of 5 additional hours of work to that panel.

Facility-based services, Home Health Care Agencies, and DMEs will all take over 20 hours to complete the credentialing process.

Q: Have you ever credentialed or worked with providers in my area?

You bet! We have credentialed literally thousands of providers across the United States, including providers as far off as Alaska and Hawaii. No matter where your practice is, we have the experience needed to get you credentialed.

Q: Have you ever credentialed or worked with providers with my license type/specialty?

We have credentialed healthcare providers of more types than we can list: from chiropractors to behavioral health providers to surgeons. If you are eligible to be credentialed, we can get you credentialed!

If you are providing a service that is new and innovative, we also offer research with the insurance companies to see if your specialty is eligible for credentialing. This can save you hours of headaches reaching out to the individual insurance panels.

Q: Am I guaranteed to get on the panels I choose?

If you are fully licensed, we should have no problem identifying plenty of insurance companies and third party payers for you to be credentialed with. In some areas, some panels can be very selective or closed. In these instances, we will talk with you about the likelihood of a successful credentialing process. We want you to get the most out of your credentialing investment, but we cannot guarantee that insurance panels will accept you.

Q: What if the insurance panel I want to be credentialed with is closed?

Finding out a panel is closed can be frustrating. However, sometimes when panels say they are closed, they are still accepting providers, but on a limited basis. In the case of a panel saying that they are closed, we can and will submit an appeal when possible to the insurance company on your behalf. During an appeal, we will try to connect with the insurance company representative assigned to your area. We will then stress important parts of your qualifications and clinical practice. For instance, perhaps you have a specialty that the insurance company desires, or you are practicing in a neighborhood that is underserved. We do have success with many of our appeals. However, if a company is saying that their panel is closed, it might not be possible to get on the panel at that time.

 

Q: What if all the insurance panels are closed?

This situation is extremely rare as most insurance panels are consistently looking for new providers to add to their network. If panels are closed we will submit a formal appeal on your behalf when possible and advocate for you with the insurance companies.  During this appeal, we make a case as to why you are unique and why you should be allowed onto the panel. We have a very high success rate when it comes to appeal approvals.

Q: Can interns / limited-license providers be credentialed with insurance companies?

Sometimes, but it is highly unlikely. We have had success credentialing such providers on a limited basis—generally in areas that are very underserved. In most cases, insurance companies are looking to network exclusively with fully licensed healthcare providers. As an intern you can typically bill through a supervising provider.

Q: How long do I need to wait after getting licensed before I can get on insurance panels?

If you are a fully licensed provider most insurance companies will accept you right away even if you don’t have years of experience in the field. There are some panels that have certain regulations and may require a specific amount of experience. Your Credentialing Specialist will be able to help you navigate these requirements when recommending panels.

Q: Can I get credentialed with an EAP (Employee Assistance Program)?

Yes! Like insurance companies, EAPs are valuable third party payers to be credentialed with. The credentialing process is very similar to being credentialed with insurance companies. In fact, some of the major insurance companies also offer an EAP. Popular EAPs include: ComPsych, Optum, Magellan, Value Options, and Cigna.

Q: How much does credentialing cost?

We charge per panel, per provider that you apply to.  We do not have start up fees, hidden charges, or recurring monthly charges for your initial credentialing.  You only pay for the work we do. Our pricing does vary by the type of credentialing you need. Prices start as low as $199 per panel.  Call our Business Development Office at 855-664-5154 to get a quote.

 

Q: What is CAQH?

CAQH stands for Council of Affordable and Quality Healthcare.  It is a nonprofit that was created several years ago by the private insurance panels.  Most commercial payers require that you have the CAQH profile completed before you begin the credentialing process.  Panels use the CAQH to verify providers personal information as well as education and work history.

Q: Why is credentialing important?

Proper credentialing with the insurance panels is instrumental for operating an insurance-based practice. In order to bill efficiently and effectively, providers must be credentialed with each panel that they wish to bill. If the credentialing is not correct, your claims to the insurance panels can be delayed or even denied.

Q: What is a panel?

A panel is usually the equivalent of an insurance company. The term is commonly used to refer to a panel of plans. This is demonstrative of the fact that when a provider is on a panel he or she can bill for all of the plans under that panel.

Q: What is an NPI number?

Your NPI is a National Provider Identifier.  It is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).

The NPI 1 number identifies your license type, license level, and specialty.   Panels require that you have your NPI 1 before you begin the credentialing process.

Q: What is an NPI 1 and NPI 2 and do I need both?

An NPI 1 identifies you as the rendering practitioner, or the one providing the service. It’s like your social security number within the medical community. It follows you for the duration of your career. Regardless of who set up your profile, this identifier is unique to you. You take it with you wherever you work.

An NPI 2 is an organization identifier. It identifies the place you are providing the service. If you work for an agency this would be your employer’s company name and information. If you are in private practice this would be in your business name.

We recommend that anyone whose business has a tax ID acquire an NPI 2. From a credentialing perspective, this allows your contract with insurance panels to be at the organization level for applicable panels. Then your NPI 1 is linked to the NPI 2 for billing purposes. Therefore, your business is paid for your services. This becomes especially important as you grow your business and your team.

Additionally, some insurance panels like Medicaid, Medicare, and BCBS require the NPI 2 in order to credential with them if your business has a tax ID.

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