The 2 Paths to Getting Credentialed

How should you go about getting credentials? This is one of the top questions that comes to us at Collaborating Docs. We help nurse practitioners find great collaborating physicians, mostly for nurse practitioners starting their own entrepreneurial endeavor. So it's sort of a big decision. How am I going to go about making sure payers are going to accept my patients and pay for their care? So please stay tuned to learn the two paths that you can take to get credentialed.

Hi, I am Dr. Annie DePasquale. I am the founder of Collaborating Docs and I'm here to talk today all about credentialing. So if you've already made the decision that you do want to take medical insurance in your practice, then you're going to have to go about the task of getting credentialed by those payers. So there are two separate paths on how to do this.

The first path is DIY. Do it yourself so you can contact the insurer's carrier that you want to use or be carried by and get the form. Usually it's a packet, a pretty lengthy form. Sometimes it's online, sometimes you can print it out. But get the form, fill it out, submit it, and then do a long wait to hear back from them. A lot of these companies take months to get it done. It just is a long process. There's no easy way around that particularly. You just have to submit it as accurately as you can and then wait to hear back if they have follow-up questions. So you can absolutely fill it out on your own. There's no cost to do it on your own, minus your own time.

The second path is to hire a company to do it for you. So you would tell them, these are the companies I want to be credentialed with. Go have at it, go take care of it for me. You will most likely pay a fee per company that you want to be credentialed with. You might find a credentialer willing to do sort of like a group lump sum for all of them at a discount. Or you may pay for their time.. So you could use a freelancing site to find someone to do it. I actually highly recommend that you use a credentialing company that does it day in and day out. If you hire an individual, you're kind of putting all your eggs in that one basket that that person knows what they're doing. Make sure you've vet them carefully, that they are familiar with the insurance companies that you are interested in. So perhaps they're in your state or they have worked in your state. It's hard to be an expert in every state but bigger credentialing companies have people in all the different states who have experience with them and that's why they often are a bit more efficient. So between doing it yourself, it's great if you're looking to save money and be fully in control of your own destiny. Outsourcing it to a freelancer who really knows what they're doing or a company that knows what they're doing will definitely save you time, but cost some money.

Since my company helps with collaborating, the question often comes up, well, do I need my collaborator to be credentialed? To get credentialed? The answer is, it depends. Some insurances don't care at all. They're credentialing you as a nurse practitioner. Others say, well, I want to know who the doctor is that you're partnered with. And they do require knowing that to proceed. And oftentimes they actually need that doctor to be credentialed before you. They need to know, okay, this is a legitimate physician with the right credentials so you may actually have to get your doctor credentialed first and then they'll allow you to be credentialed once that is done. So that can elongate the process because it's sort of like I have to get two sets of people credentialed back to back. So that's when things get time consuming.

Credentialing obviously is one of those sort of necessary evils. If you want to take patients who have insurance, you have to go through these steps. It's just sort of a normal part of doing business and getting your practice set up. So at least you only have to do it once, set it up, forget it, and then it's good for the rest of time. You may have to renew certain things, but the hard part is in the beginning. We do have a couple credentialing companies we recommend. So here's our website and if you click up here, services or NPs Love, you can scroll down. This is a section with three companies for credentialing at the time of this recording, we're always updating it with new companies we hear of that are great. We might remove a company if we hear they're not great, but as of this moment, we recommend these companies. You may want to have a quick consult with all of them if you're in the market and see who would be the best for your needs. Alright, I will see y'all next time. Take care.

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