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  • Writer's pictureEligibilityOneᵀᴹ

5 Tips for Provider Credentialing

Here are 5 tips for provider credentialing to help you navigate the complex credentialing process that can often seem overwhelming.

Credentialing Tip #1: Don’t Delay!

This may be the most important credentialing tip: Get started ASAP. Begin collecting and organizing relevant documents and other material immediately. This includes CVs, references, updated contact information, education/work history, and more.

Even if a payor won’t start the credentialing process until 60-90 days out from a provider’s start date, it’s never too early for you to prepare. Because the credentialing process is lengthy and affects reimbursement, some healthcare organizations will not schedule a new provider’s start date until they’ve received all credentialing paperwork from the new hire. For example, you may not be able to start until 120 days AFTER you’ve submitted all (complete and accurate) requirements.

Many providers find that the credentialing process takes longer than expected. Do everything in your power to prevent delays that can result in postponed employment start dates and claim denials.

Credentialing Tip #2: Be Proactive

Anticipate that there will be issues. Besides starting the credentialing process early, there are other actions you can take to minimize your chances of encountering delays.

For example:

  • If three references are required, obtain five. This way if one of your references can’t be reached, it won’t hold up the rest of your application.

  • If you can help it, don’t wait until the summer to start the credentialing process. Payors receive a lot of applications in the months following graduation, so you’ll probably see delays during this busy time.

  • Triple-check your paperwork and have another experienced professional look over your application to make sure you’re not missing anything. Mistakes and omissions are major causes for delay. If everything is correct on your first submission, it will save you a lot of hassle down the road.

  • Follow up. Stay on top of your application by checking its progress at least weekly. This will ensure you detect and resolve any deficiencies as soon as possible, since many states allow 60 days or more for payors to inform you of errors.

Credentialing Tip #3: Understand Your State’s Regulations

Be aware of your state’s unique requirements or allowances. For instance, in some states you can bill for services performed during the credentialing process and in others you cannot.

Reciprocity agreements also exist between certain states and payors. If you’re already credentialed with a payor in one state, the payor may fast track your credentialing for another state!

Keep yourself updated on changes to industry laws at both the federal and state level so you can avoid any new or obscure rules falling through the cracks and causing difficulties.

Likewise, you wouldn’t want to miss out on the benefits of laws that work in your favor, such as those related to reciprocity.

Credentialing Tip #4: Use Credentialing Technology Solutions

We’re not talking about spreadsheets! You no longer need to manually track your compliance using this outdated method.

EligibilityOne offers a messaging alert system that updates you throughout the entire credentialing process. We also send automated reminders to providers 30, 60, 90, and 120 days prior to expirations of licenses, certifications, and other compliance requirements. You won’t miss critical deadlines because you’ll automatically be notified well before malpractice insurance must be renewed or continuing education credits are due.

Additionally, EligibilityOne technology can auto-populate forms, making the extensive amount of credentialing paperwork more manageable. We also recommend using our cloud-based technology for easier and quicker access to data, which speeds up the credentialing process.

Credentialing Tip #5: Outsource Credentialing

When you outsource with EligibilityOne not only will you gain the benefits of our technology solutions, but your credentialing work will also be handled by a team of credentialing experts. You won’t have to worry about many of the credentialing tips above, such as keeping track of industry changes or following up on applications, because we will do those things for you – plus much more.

Whether you outsource credentialing or give it a go yourself, these 5 tips for provider credentialing will help make the process much smoother, faster, and an overall success!


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