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Table of Contents
How long does the credentialing process usually take?The credentialing process can take anywhere from 6 weeks to one year depending on the health plan. The average amount of time for a health plan to credential a provider, however, is around 3-4 months. Back to Top
What can I do to expedite the process?Provide accurate and complete information to us so we can transfer that to your credentialing applications. The number one reason for delayed and returned credentialing applications is missing information! Back to Top
Will every health plan accept me as a provider?No. Each health plan has it's own set of rules and regulations and they determine who participates and who does not. Some plans will have enough specialists or Primary Care physicians in an area and may not need a contract with you. That doesn't mean you can't re-apply at a later time. You could also consider having physicians in the area and patients to write letters on your behalf to the health plan. Back to Top
Once I am accepted, can I bill retroactively for services rendered?Most health plans will not allow you to bill retroactively for services rendered prior to your acceptance as a participating provider. Medicare and Medicaid, in some states, will allow you to bill retroactively but that should be verified before seeing patients. Back to Top
Will Credential America Physician Services negotiate my contracts and fees?At this time, Credential America Physician Services provides the provider enrollment services only. However, through a national network of consultants, Credential America can offer support. Back to Top
How do I get started with Credential America Physician Services?Complete the information request form OR call us at 888.288.1880. We can e-mail or mail you the materials you will need to get started TODAY! Back to Top
Why does it take so long for health plans to respond to requests for applications? When calling a health plan to request credentialing applications for a provider, we are frequently asked to provide information about the provider BEFORE a credentialing application can be sent. This information is often presented to a committee or even a supervisor for approval first. As you are probably aware, most health plans are becoming increasingly selective about the providers with whom they contract. If a physician does not admit to one of the health plan's hospital, for instance, he/she could be rejected from the plan and it would be a waste of time to go through the credentialing process. Sometimes health plans require letters of intent. This means we can not make a phone call. Rather, we must send a request in writing which includes information such as specialty, location, board certification, etc. Again, once the request is received, there is an approval process that must happen before an application will be sent. While this is not true for ALL health plans, we do find that it is very common with most of the health plans.
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