Is Medical Credentialing Giving You a Headache?

Here are some simple tips to lessen the stress of credentialing your providers:

• Download the health plans credentialing guidelines.
• Many health plans provide their guidelines on their provider manuals. If you are unable to locate on the website, call your provider representative. They are happy to share the information.
• Add all locations where your provider will be practicing.
• For Primary Care Physicians (what location are they going to be a PCP?)
• Make sure to specify which locations are primary.

 

CAQH

• Who is attesting, provider or office? (Allows provider and group administrators to enter information once and share it with all the plans they authorize. This reduces administrative burdens and errors and allows practices to focus on what matters.)
• Remember this needs to be completed every 120 days.
• Make sure all new locations are added in CAQH.

Follow up with your payers.

• Create a document that allows you to know time sensitive information as in when you sent the application and to whom it was sent to.
• Keep your providers or team updated with application or eligibility dates.
• Be sure to confirm if it is a provisional date or PCP provider status.
• Create an alert system that will remind you when re-credentialing occurs, or attestation is needed.

CAQH For Providers

• Re-attestation Critical as Healthcare Organizations Return to Normal | CAQH

 

Brought to you by the West Chapter.