We would like to review with you the items which are required by carriers to complete and/or start your credentialing process. As you may or may not know, whenever a provider starts to work with a new entity (business with a different EIN/Tax #) it is required that we associate you with the new group. This is why we must have accurate, legible, and complete copies of all information to have the credentialing and contracting completed on your behalf within the normal timeframe of 90-120 days. Not receiving the information will only prolong this process, and will delay payment from carriers for services rendered before the given effective date. We understand that it is and seems to be a tedious process, but it is what the carriers require.
Once we receive all the needed information, we will create a SharePoint file that will hold all your documents and applications. If you are part of a group, we will send the practice administrator a spreadsheet that lists all communication with carriers and a listing of effective dates by the carrier. This report is sent monthly until credentialing is complete.
Below is a list of items that are required for our team to complete your insurance applications. Most items can be obtained within CAQH.
Please complete the credentialing information sheet below. Please note the areas marked with asterisks (*), there are required items.
The NPPES login is required in order for us to complete your Medicare application. If you don't recall your NPPES login, you may go to the website and click on Help, where you may contact NPPES for website assistance.
The CAQH is required to update your information to add the new group to your active practice locations and to add us as a contact for re-attestation. The credentialing information sheet may be replaced once we have secured a CAQH login and all documentation and information have been updated and uploaded.
What is CAQH? CAQH is a central data hub for insurance companies to extract provider information, rather than having to complete an application. The following carriers utilize CAQH: Humana, United, BCBS, Aetna, Cigna, Molina, and Multiplan. Some insurance companies still have the credentialing specialist complete an application, but then they refer to CAQH as well. So it is important to have all information accurate and complete.
If you don't know your CAQH login information, please contact CAQH support at 888-599-1771 to reset your login information, or go to https://proview.caqh.org/Login/Index?ReturnUrl=%2f to reset your login information.
Once you have completed the Credentialing Information Sheet and gathered all the required documents, please email them to firstname.lastname@example.org. Once we have received all the required information we may start working on your credentialing. Please note: the typical time frame for credentialing and contracting is 90-120 days depending on the carrier and if all information requested was received within a timely manner. *Please note, some insurance carriers are currently backlogged and are experiencing time frames of up to 180 days.
We look forward to working with you.