Provider Credentialing Mistakes that Could be Hurting Your Bottom Line

Credentialing new providers is a vital task that every medical practice must complete. It’s also an often complex process that can be prone to costly mistakes. Errors in provider enrollment and credentialing can create a wide range of profit-hurting issues, from scheduling delays to fluctuations in your practice’s revenue cycle. To help you avoid the consequences of these errors, we’ll take a look at the most common provider credentialing mistakes that could be hurting your medical practice’s bottom line.

Mistake #1: Trying to Rush the Credentialing Process

If your practice is bringing on a new provider, it is essential to set aside an adequate amount of time for the credentialing process. If you don’t set aside enough time to prepare the appropriate documentation and process applications/insurance approvals before your new provider arrives, they may be left unable to bill their patients for the services that they provide. At Bikham Healthcare, we recommend that medical practices begin the credentialing process at least 120 days in advance. This allows you time to complete essential steps such as re-attesting CAQH profiles, processing applications and receiving payer approvals, reviewing your documents carefully for accuracy and completion, and asking any follow-up questions that you might have for your new provider. It’s also important to keep in mind that many payers take several months to process new provider approvals. This is especially true of government payers such as Medicare and Medicaid, which sometimes take as long as six months to process and approve a new provider application.

Mistake #2: Failing to Follow-Up Throughout the Application Process

Credentialing a new provider requires a lot of important documents to be sent back and forth between payers and your practice. If even one of these documents is misplaced or never received, it could create a disruption that upends the entire application process. While it’s nice to believe that your practice and the payers you work with are both detail-oriented enough to avoid such a mistake, documents that are misplaced or never received is an unfortunately common issue. In order to avoid the lengthy delays created by a document that never arrives at its intended location, it’s important to keep an open line of communication with the payers you are submitting applications to. Follow up with them regularly to ensure that they have received each new document that you send. Keep in mind that most payers will not contact you themselves to inform you of a delay in your application’s processing, so it’s up to you to follow up with them throughout the application process to ensure that they have everything they need to complete your application in a timely manner.

Mistake #3: Errors or Omissions in Your Application

If you are submitting an application for a new provider, even the smallest error or omission in the application can lead to costly delays. In many cases, an error in the application you submit can cause your application to be denied, forcing you to start the time-consuming application process all over again. In order to avoid the many headaches that can be created by even one simple error, it is essential to carefully review your applications multiple times before sending them in. At Bikham Healthcare, some of the most common mistakes that we have seen on new provider applications include mistakes such as:

  • Inaccurate or incomplete data
  • Incorrect NPI numbers
  • A lock box address that is incorrect or incomplete
  • Misspelled names

Given the fact that many payers can take months to process an application, being forced to start the application process all over again due to a mistake that amounts to little more than a single typo is certainly a frustrating and costly situation. To avoid finding yourself in this unfortunate situation, be sure to check and double-check every application that you submit. It may also be helpful to have multiple employees at your practice review each document; the more sets of eyes you have searching for errors, the more likely you are to spot a mistake that might otherwise slip in unnoticed.

Mistake #4: Failing to Update Your CAQH Profiles

The Coalition of Affordable Quality Healthcare (CAQH) was designed to relieve the administrative burden of physicians and medical practices by creating a credentialing database that stores all provider information and participating healthcare plans in a single, convenient location, allowing healthcare providers to submit a single credentialing form to multiple payers. While CAQH is meant to simplify the provider credentialing process, it can also create its own set of problems and delays if the information on your CAQH profiles is not up to date. CAQH profiles are required to be re-attested every 120 days, so make certain that your CAQH profiles are complete with accurate and up-to-date information before you begin the credentialing process in order to avoid any costly delays.

Let Bikham Healthcare Take the Hassle out of Provider Credentialing

At Bikham Healthcare, we understand that provider credentialing is one of the necessary evils of running a medical practice. When even one small mistake can upend your application process and create costly delays that hurt your practice’s bottom line, it is essential to ensure that you are completing every step of the provider credentialing process in the most accurate and efficient manner possible. Thankfully, our industry-leading provider credentialing services are designed to take this burden off of your shoulders, freeing you up to focus on caring for your patients and growing your practice.To learn more about how the provider credentialing experts at Bikham Healthcare can help you avoid all of the hassles and costly potential errors associated with healthcare provider credentialing, feel free to contact us today. A friendly and knowledgeable customer service representative will be happy to answer any questions that you might have and walk you through our proven approach to timely and accurate provider credentialing.

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