Many healthcare startups and expanding clinics view “Credentialing and Provider Enrollment” as a mere checkbox. In reality, it is the gatekeeper of your revenue. If a provider is not properly credentialed with a payer, the insurance company simply will not pay the claim—no matter how life-saving the treatment was.
The High Cost of Credentialing Delays On average, the credentialing process in the USA can take anywhere from 90 to 120 days. For a high-volume specialist, every day spent “out of network” while waiting for a payer to process an application can result in thousands of dollars in lost revenue.
Common Credentialing Pitfalls:
- Incomplete CAQH Profiles: The Council for Affordable Quality Healthcare (CAQH) is the industry standard. An expired license or an old address in this system can stall your enrollment for months.
- Missing Primary Source Verification: Payers don’t just take your word for it; they verify your medical school, residency, and board certifications at the source. Any discrepancy leads to an immediate rejection.
- Lapsed Malpractice Insurance: A gap of even one day in your coverage history can trigger a “red flag” with the credentialing committee.
How MedBill Streamlines the Path to Payment Our team doesn’t just “submit forms.” We manage the entire lifecycle:
- Primary Source Verification (PSV): We verify all qualifications before the payer does, catching errors early.
- Payer Relations: We maintain direct lines of communication with major payers (Medicare, Medicaid, and Commercial) to “push” applications through the pipeline.
- Ongoing Maintenance: We track expiration dates for licenses, DEAs, and board certifications so your revenue flow is never interrupted.
Final Word Don’t let administrative red tape stop you from practicing medicine. Proper credentialing ensures that when you see a patient, you get paid for it.