Credentialing is one of the most crucial steps in establishing your medical practice. However, it’s also one of the most complex and time-consuming tasks that can significantly impact your ability to serve patients and generate revenue. At Integrity Health Network, we understand the intricacies of the credentialing process, and we’re here to explain why trying to handle it on your own could be a costly mistake:
1. Medicare and Medicaid Approvals: The First Hurdle
Before you can even think about submitting credentialing applications to private insurance payors, Medicare must first approve your provider. Once Medicare is approved, certain private insurance payors require Medicaid approval before a credentialing application can be submitted. Medicare and Medicaid are two payors that are incredibly specific about how applications are submitted and tend to take the longest. Without these approvals, your other applications will be stalled, delaying your ability to see patients. At Integrity Health Network, we streamline this process, ensuring that everything is in order so that your applications are processed without unnecessary delays.
2. The Long Waiting Game
Did you know that insurance payors can take anywhere from 60 to 120 days to approve a credentialing application? If there’s any missing information, the timeline starts over. Imagine the frustration and potential revenue loss this can cause. Our team at Integrity Health Network has years of experience navigating these timelines, ensuring all applications are accurate and complete from the start, reducing the risk of resubmission and lost time.
3. Starting Too Late
Many providers make the mistake of requesting credentialing right before they are expected to start seeing patients. This can result in significant delays and loss of income, as providers may not be able to bill for services until credentialing is complete. We recommend starting the credentialing process well in advance and can guide you on the best timeline to follow.
4. The Devil Is in the Details
Inaccurate or incomplete information can cause major delays in the credentialing process. Keeping your work history and resume up to date is crucial, as all health plans require a comprehensive overview of your employment history. At Integrity Health Network, we take your up-to-date resume and ensure that every piece of information is accurate and up to date on each application, so you don’t have to worry about unnecessary setbacks and time-consuming data entry.
5. Communication Breakdown
Inadequate communication is a common pitfall in credentialing. Payors often require additional information, and if you don’t respond promptly, they may close your application, forcing you to start from scratch. At Integrity Health Network, we maintain open lines of communication and are always responsive to ensure that any requests for additional information are handled quickly and efficiently.
6. The Complexity of Submissions
Each payor has a different method for submitting credentialing applications. Medicare submissions are done through PECOS, Medicaid through MN-Its, and private payors may use portals like UHC’s Onboard Pro or applications like MCC and CAQH. This complexity can be overwhelming. Our team is well-versed in all these systems and handles the submissions for you, saving you time and stress.
7. Our Proven Process
Credentialing can quickly become chaotic without a system in place to track submissions, follow up on applications, and monitor approvals. At Integrity Health Network, we have designed a robust process that documents, tracks, and notifies us of every step in the credentialing journey. This ensures that nothing falls through the cracks and that your applications are approved as quickly as possible.
8. The Importance of Documentation
Submitting all required documentation is crucial to avoid delays or denials. Each provider will need to submit a variety of documents, and forgetting even one can set the process back. Careful organization and attention to detail can help ensure that everything is submitted correctly the first time. At Integrity Health Network, we have a system in place that stores all the necessary documentation so that each application has all the required information.
9. Protect Your Revenue Stream
Delays or issues in credentialing can lead to lost revenue, as providers may not be able to bill for services rendered until credentialing is complete. By ensuring timely and accurate credentialing, we help protect your income stream and allow you to focus on what you do best, caring for your patients.
Why Choose Integrity Health Network?
When it comes to credentialing, all we need is your provider’s information, and we take care of the rest. With years of experience and established connections with various insurance plans, we know how to navigate the system efficiently. Don’t let the complexities of credentialing slow down your practice or cost you money. Trust Integrity Health Network to handle the process for you, so you can focus on growing your practice and providing top-notch care to your patients.
