Navigating the insurance credentialing process can be complex and time-consuming, but at Clear Path Billing Solutions, we simplify it for you. Our credentialing services ensure you’re able to accept insurance efficiently and with minimal hassle.
We provide:
- Commercial Insurance Credentialing: We manage applications and follow-ups for commercial insurance plans, ensuring your practice is credentialed to accept a wide variety of insurance.
- Governmental Insurance Credentialing: We handle the complexities of credentialing for Medicare, Medicaid, and Tricare, ensuring all documentation is in place for timely approval.
- Ongoing Credentialing Support: Need to update your information or re-credential? We assist with renewals and ensure you remain in good standing with insurers.
What is Credentialing?
Credentialing is the process of verifying that a healthcare provider meets the standards and qualifications required by insurance companies. This essential step enables providers to accept insurance from patients, ensuring that services are covered and reimbursed by insurance plans. Credentialing involves confirming a provider’s licenses, certifications, experience, and overall suitability to work with specific insurers.
Stages of the Credentialing Process:
- Application Submission: We gather and submit your information, including provider and practice details, licenses, certifications, and any other required documentation.
- Primary Source Verification: Insurers review and verify all credentials, including qualifications, licenses, certifications, and any required background checks. This step ensures compliance with their standards.
- Payer Approval and Contracting: Once credentials are verified, the payer approves the provider for network participation. Contracts are then finalized, allowing the provider to bill and receive payments from the insurer.
Typical Credentialing Timelines:
- Commercial Insurance Credentialing: 60 to 90 days, depending on the insurer and completeness of submitted information.
- Governmental Insurance Credentialing (Medicare, Medicaid, Tricare): 90 to 120 days, as these may involve additional verification steps and approvals.
- Commercial Insurance: $100 per application
- Governmental Insurance: $150 per application
- Re-credentialing: $50 per application
