Medical Credentialing – Getting Started


Medical Credentialing is Important for Building a Successful Practice — What else do I Need to Know?

Medical Credentialing is the process of becoming affiliated with insurance companies so that you (the medical provider) can accept third party reimbursement.

While important for the success of a clinical practice, medical credentialing is an unwelcome distraction from providing quality care to patients–but it doesn’t need to be!

Today’s Patients Want to Use their Insurance

Just a few years ago, health professionals considered medical credentialing to just be optional for building a practice. Today, it has become more necessary than ever for providers to be networked with insurance companies. This is partly because more people in the U.S. have health insurance than ever before, but even more-so because patients desire (even demand) to use their health insurance when seeking healthcare services (rather than out-of-pocket payment).

Get on insurance PanelsInsurance Plans are Covering more Services (Pre-existing conditions, Mental Health, etc.)

Medical credentialing is becoming more important as health insurance plans are becoming broader in regards to the scope of treatments they cover. These changes include Mental Health and Behavioral Health parity, less restrictions on pre-existing conditions and the coverage of supplemental services, such as physical therapy, massage therapy, acupuncture and other holistic health services.

Insurance Panels are Getting Full and Closing!

Unfortunately, insurance panels (for providers) are increasingly becoming full — meaning the process of medical credentialing is becoming more difficult every day, as insurance companies close provider panels and make the barrier for physicians, counselors or any health professionals higher and more difficult to climb.

**That being said, some panels that claim to be “closed” are really just being selective about which providers they are adding. Knowing how to position one’s self and expertise can go a long way when it comes to getting into “closed” panels.**

Medical Credentialing Help!

This website will provide helpful articles and tips for getting credentialed with insurance companies. Alternately, if you’re looking for a medical credentialing service that can take the burden of credentialing off of your plate, we can do that too. We’d love to talk with you about our full-service medical credentialing offer that guarantees success. Please feel free to call us at 1-855-4-THRIVE (1-855-484-7483).

How Long Does the Process take?

The process of credentialing can be a challenging and lengthy one, and generally takes between 3-4 months to submit the paperwork, submit supplementary documentation, and correspond with insuranace companies’ credentialing departments.

Because of the large amount of paperwork and correspondence that is required, medical providers generally find the process to be undesirable, and very time-consuming. That is why many counselors choose to be cash-only practices. But every client that you turn away for not accepting their insurance, is money that you can never recover from. In fact, many patients today are demanding that their counselor accepts their insurance.

Hence, insurance credentialing services such at Thriveworks (that’s us) are often an affordable and effective alternative to the DIY approach.

After wading through the process of credentialing ourselves, we have developed and mastered the credentialing process. It does not have to be so challenging. For more information or to get started on insurance credentialing, give us a call today.

Comments

  1. Janet says

    Thanks for the excellent work getting me onto insurance panels. I’ll be telling other counselors I know about your excellent service! :-)

  2. Chris L. says

    I have been thinking about trying to get on panels, but colleagues have told me that the panels in my area are closed. Is your service able to help with that?

    • Thriveworks says

      Hi Chris! That’s a great question. We find that many panels that people believe to be closed are not 100% closed, but are simply being very selective about who they are accepting. We have very good success at getting providers on excellent panels, even in areas that are “saturated” with health providers. Chris, we’d love to talk with you more about this–please feel free to call us a 1-855-4-THRIVE.

      Warmly,
      Your Friends ar Thriveworks Credentialing

  3. Patricia Cedeno-Zamor says

    Dr. Centore:

    I continue to read your articles about insurance panels, ethics, and other related behavioral health matters. I hope that you or someone at Thriveworks will contact me at ##### to discuss how our clinic can move forward to become credentialed to provide CSP, InHome Therapy and Therapeutic Mentoring through the 5 panels we listed in our initial application. We now have a clearer understanding of level of licensure required that enable providers to deliver out-patient services. We are preparing this updated information that will be resubmitted as soon as we receive a response from Thriveworks.
    We look forward to hearing from you and continuing the process,

    Best regards,
    Patricia
    RMSC

  4. Emeka says

    I want to start a mobile x-ray services to patients in my communitry who do not have easy access to a traditional radiology or imaging centers. Can your service help someone like me get credentialling from major healthcare Insurance companies?

    • Thriveworks says

      Yes, very possibly! We’d love to hear a bit more about what you’re hoping to accomplish. Would you like to call us at 1-855-4-THRIVE?

  5. Tamera says

    Hi – What is a CAQH. I would like to try to get credentialed with Health Partners – please contact me. I have started the process and am going under a clinic. The clinic, however, is not credentialed with HealthPartners. I would like to see how much this would cost me. I have already sent in my application for Blue Cross, Preferred one and Medicaid.

    Thank you,
    Tammy

  6. daniel says

    I would like to know the costs of credentialing through Medicare, CAQH, and other insurance providers not using CAQH on the central east coast of florida. I am board certified in family medicine.

  7. Auzadeh says

    I have question about your ‘sale’ price.
    – Whether or not you can credential through an agency rather than an individual.
    – How soon after (or before) a person becomes indepdentely licensed (LISW) you need to begin the credentialing process.
    – and, questions regarding introductory level practitioners being covered through an agency.
    Please contact me at …

    • Thriveworks says

      Greetings Auzadeh,

      I will have our salesperson call you straight away….also, you can reach us anytime at 1-855-4-THRIVE. Sincerely, Anthony

  8. TaKeishia says

    I can not beleive how much dedication you set in to this particular ! creative is the best way to begin to spell it out this specific. Carry on the truly great work !

  9. grape says

    Admiring the persistence you put into your blog and detailed information you offer.
    It’s good to come across a blog every once in a while that isn’t the same unwanted rehashed material. Great read! I’ve saved your site and I’m including your RSS feeds to my Google account.

  10. fran says

    I am a LCSW with over 30 years of experience and also a certified hypnotherapist specializing in smoking cessation. I have a small private practice and am considering accepting insurance-can youhelp with that in this area(Memphis). Also, what is your charge for this service? thank you. Fran Theos

  11. Tiffany says

    I am having a Herculean amount of trouble finding an answer to this question in under a week. I bet you can help me though! Which insurance companies in the state of Florida pay LCSWs to provide services?

  12. Tiffany says

    I am an LCSW who is doing expert witness work in court. I have state attorneys and even judges who contest that I have the qualifications to to diagnose and treat people. I feel like these people see social workers as more of case managers and do not realize that no- indeed we are psychotherapists who are qualified to run private practice. I am trying to compile proof to bring to court that LCWSs are allowed to diagnose and treat people and I thought a novel way to do that would be to provide a list of the names of insurance companies IN THE STATE OF FLORIDA particularly who reimburse us for services rendered. CAN YOU PLEASE HELP ME? This info has been hard to unearth.

  13. Ivy says

    You have a spelling error on the front page of your website. Under “Today’s Patients Want to Use their Insurance” The word is “lieu”, as opposed to leu.

  14. Acq Bryant says

    Do insurance credentialing services have to be licensed by the state?
    How will a client know they are getting the best rate?
    If a client is declined , is there a fee for negotiating?

    • Anthony Centore says

      Hi Acq. Good questions! Credentialing services do not need to be licensed by the state. There is no such certification, actually. Haha, that would be kind of funny…this credentialing company needs to be credentialed :-) Regarding your question about best rates, I guess the best way to see if someone has been quoted the lowest price is to ask around. At Thriveworks, our rates are very competitive, and the we really work hard to make sure that our customers’ experience and outcomes are very positive. Regarding your final question, the answer is “it depends.” Give us a call and let us know what kind of provider you are, and which companies you’re wanting to work with!

    • Anthony Centore says

      Greetings Vivian!

      We have credentialed thousands of providers across the USA, including Hawaii and Alaska!

      Regarding Puerto Rico, I don’t know if we have ever had the pleasure to do so.
      The process is different from state to state, but the general principles of credentialing stay the same.

      I’d like to talk with you a little about Puerto Rico! Would you like to give me a call at 1-855-484-7483?

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