Nine commonly asked Provider Enrollment and Credentialing Questions

At Bikham Healthcare, we understand that provider enrollment and credentialing can be a confusing and frustrating process for many healthcare providers. Unfortunately, it is also an all-important process that cannot be taken lightly. To help clear up some of the confusion surrounding the process of credentialing and enrolling new providers, we’ll take a look at some of the most commonly asked questions that we have encountered during our time helping healthcare providers throughout the provider enrollment and credentialing process.

What’s the difference between Provider Enrollment and Provider Credentialing?

While provider enrollment and provider credentialing are closely linked, it is important to note that they are two separate processes. Provider enrollment is the process of enrolling a new provider with payors such as Medicare, Medicaid, or private payors so that they are able to seek reimbursement for the services that they provide. Provider credentialing, meanwhile, is the process of obtaining and verifying a provider’s credentials and qualifications to provide patient care. Before a new provider can begin providing care at your healthcare practice, both of these processes must be completed.

How long does it take to enroll a new Provider with a Payor?

The exact amount of time that it will take to complete the provider enrollment process ultimately depends on the payor(s) that you are working with. With that said, though, it is important to understand and prepare for the fact that the enrollment process can often take quite a long time. With government payors such as Medicare or Medicaid, for example, enrolling a new provider can sometimes take upwards of six months. With this being the case, it’s essential to begin the enrollment process as soon as possible.

What is CAQH?

CAQH (Coalition of Affordable Quality Healthcare) is an online database that is meant to help streamline the process of enrolling and credentialing new providers. By storing information from both providers and payors in a single, convenient location, CAQH makes it possible for healthcare providers to access a number of time-saving tools and features. For example, the ability to complete a single enrollment application and submit that application to multiple payors at a time is one popular feature offered by CAQH. If you are looking to cut down on some of the time and hassle associated with the enrollment and credentialing processes then CAQH is certainly a resource worth taking advantage of.

How often does a Provider need to be Credentialed?

In addition to performing the credentialing process for any new provider that joins your practice, you will also be required to credential all current providers at your practice at least once every three years. For some payors, provider credentialing must be completed even more often than this.

What can I do to avoid delays during the Provider Enrollment and Credentialing process?

Enrolling and credentialing a new provider is a time-consuming process. There’s nothing more frustrating, therefore, than being forced to start the entire process all over again due to a simple error. Unfortunately, this scenario is much more common than many healthcare providers realize. Even a simple mistake such as an incorrect address or a misspelled name can cause payors to reject your application, forcing you to submit the application over again and return to the back of the line. In order to avoid the costly delays created by even the simplest of mistakes, it is essential to pay careful attention to every single detail that you submit. Check and double-check each form that you complete to ensure that there is no missing information and that the information you do submit is completely accurate.

Do Physical Therapists need to be Credentialed?

Yes. Any healthcare provider that provides services that are covered under insurance needs to be credentialed and enrolled with the appropriate payors.

Are References required during the Credentialing process?

In many cases, providers will be required to provide references as part of the credentialing process. These references can include healthcare professionals who have worked with or otherwise observed the provider in the past, healthcare professionals in the same specialty as the provider, or healthcare professionals who have been recently responsible for the provider’s practice such as a chief of staff or department chair.

Are there any tools that can help simplify the Provider Enrollment and Credentialing process?

The good news for healthcare practices that are overwhelmed by the process of credentialing and enrolling new providers is that there is a wide range of tools available that are designed to streamline the process and help eliminate some common sources of errors. This includes tools that are designed to automate the process of filling out a new application by automatically populating the form with information that is pulled from a database such as CAQH.

How can Bikham Healthcare help with the process of Credentialing and Enrolling Providers?

At Bikham Healthcare, enrolling and credentialing providers is our expertise. Over the years, we have helped countless healthcare practices eliminate the burden of provider enrollment and credentialing by doing all of the heavy lifting for them. By leveraging the latest in automation technology along with a proven process and decades of combined experience, we are able to complete the processes of provider enrollment and credentialing in a way that is as timely and accurate as possible. To learn more about how Bikham Healthcare can take the stress out of provider enrollment and credentialing with our industry-leading services, be sure to contact us today.