Provider Credentialing Vs Provider Enrollment: What’s the Difference?

In many ways, provider credentialing and provider enrollment are two sides of the same coin. Both are vital processes that must be completed by a healthcare practice before a new physician can begin accepting patients at that practice – and both are processes that can often entail a lot of time and hassle.

In this article, we’ll take a detailed look at what provider credentialing and provider enrollment are, the key differences and similarities between these two all-important processes, and how Bikham Healthcare can help ensure that your practice performs the processes of provider enrollment and credentialing in the most efficient way possible.

What is Provider Credentialing?

Provider credentialing is the process of checking the credentials of a new provider before they are hired by a healthcare practice. While this process is typically performed by the healthcare practice that is bringing the new provider on-board, insurance payers require the same provider credentialing information as part of the provider enrollment process – a process we will discuss in the next section.

Some key points of information that the provider credentialing process should produce includes information such as:

  • Name, DoB, address, and other basic information of the provider being credentialed
  • National Provider Identifier (NPI) number
  • Continuing medical education documents
  • Malpractice claims history
  • Medical group affiliation
  • Proof of professional liability insurance
  • Sanctions or disciplinary actions
  • Education and training
  • Specialty certificates
  • Board certification
  • Peer references
  • And more…

As you might imagine, gathering this litany of information can often be a very time-consuming process. In most cases, the process of gathering all of the requisite information for credentialing a new provider takes around 60-90 days. However, it’s important to set aside even more time than this to ensure that you are not rushed.

What is Provider Enrollment?

Closely related to the process of provider credentialing is the process of provider enrollment. While provider credentialing entails checking the credentials of a new provider to ensure that they are qualified and a good fit for the new position they are taking on, provider enrollment entails enrolling a provider with insurance payers so that are able to request payment from those payers for the services they perform.

In order to complete the provider enrollment process, you must first complete the provider credentialing process since payers will require all of the information that the credentialing process produces before they are able to enroll a new provider.

Like provider credentialing, provider enrollment can often be a very time-consuming and frustrating process. Since every payer has their own unique requirements when it comes to what is required to enroll a new provider, the provider enrollment process often involves filling out and submitting dozens if not hundreds of different forms. Most frustrating of all is the fact that most payers will require you to start the application process all over again if there are any mistakes on one of the forms that you submit – no matter how minor that mistake might be.

Tips for improving the process of Provider Credentialing and Enrollment

For many healthcare practices, provider enrollment and credentialing is a rather distasteful chore. Thankfully, there are a number of ways that you can make the processes of credentialing and enrolling new providers less of a hassle.

The first tip for improving the processes of provider enrollment and credentialing is to make use of automation software. While every insurance payer has their own requirements when it comes to the information they require for enrolling a new provider, many of the forms you will need to submit will be populated by the same, basic information. Making use of automated software designed to fill out this basic information for you, therefore, is a great way to save quite a bit of time. Online databases such as The Coalition of Affordable Quality Healthcare (CAQH) that automatically populate forms with information from the database are another helpful resource to consider.

It’s also important to give yourself plenty of time for completing these all-important processes. Nothing is worse than having a new provider who is unable to accept payments from the patients he or she receives due to the fact that the credentialing process or enrollment process are behind schedule. The more time that you give yourself, the less stressful the process is sure to be.

Lastly, it is essential to check and double check all of the information on each and every form that you submit. We’ve already discussed the fact that even an error as minor as a misspelled name or address can cause an application to be rejected and force you to start over again from the back of the line. To avoid this unfortunate scenario that far too many healthcare practices find themselves in year after year, it is vital to go over every document with a fine tooth comb.

Let Bikham Healthcare take the stress out of Provider Enrollment and Credentialing

While there are several strategies designed to make the processes of provider enrollment and credentialing more efficient, by far the best way to ensure that these processes are completed in a timely and professional manner is to work with an established provider credentialing and enrollment service provider.

At Bikham Healthcare, we have decades of experience helping healthcare practices across the country credential and enroll new providers. When you work with the credentialing and enrollment experts at Bikham Healthcare, you can look forward to having these processes completed on your behalf with little work at all required on your part. Best of all, working with an experienced provider credentialing and enrollment service provider is an excellent way to ensure that you don’t make any costly mistakes.

To learn more about how Bikham Healthcare can help with all of your provider credentialing and enrollment needs, feel free to contact us today!

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