Insurance Credentialing Timeline

The most often asked question when speaking with a healthcare provider about insurance credentialing is, “How long does it take to get credentialed?”.  This is a difficult question to answer because the turn around times of carriers vary widely.  nCred tracks the amount of time each payor takes to complete the credentialing process for our healthcare provider clients.  Let’s take a look at a sample of actual results.

Medicare

Believe it or not, Medicare enrollment is one of the faster processes to complete.  A limited sample of 500 Medicare provider enrollment applications processed by nCred with various Medicare intermediaries around the country reveals an average time to completion of 41 days.  That average consist of the time that an application is submitted to a carrier until the time the carrier notifies of completion.  The quickest turnaround was 11 days (Massachusetts – NGS) and the slowest turnaround was 86 days (Georgia – Cahaba). 

It is important to note that the enrollment applications sampled were processed on first submission and did not have any errors that required Medicare to request corrections or additional information.  This application sampling is from physician (as defined by CMS) applications and did not include any DMEPOS applications which can take 120 days or more due to the detailed screening and fingerprinting required.

A positive note about Medicare provider enrollment is that your effective date with Medicare will be the date the carrier receives your application no matter how long it takes them to complete the process.  If you start seeing Medicare patients prior to your application completion, you can back bill from your effective date once the application is completed.

Commercial Carriers

The process with commercial carriers involves 1) submission of the carriers credentialing application or enrollment request form, 2) the carrier verifying all of all the healthcare provider’s credentials, 3) approval by the insurance carriers’s credentialing committee, and 4) mutual execution of a participating provider contract.  We typically see the credentials verification process completed in 60 – 90 days and the contracting phase complete in another 30 days for a total of 90 – 120 days from the time an insurance company receives the providers credentialing application.  This timeline should be considered a general guideline for a standard credentialing process.  Variances based on the type of provider, background, education and training, and other factors can have a dramatic impact on the total turnaround time of credentialing applications. 

A sampling of 1,000 insurance credentialing applications processed by nCred with carries throughout the country revealed an average completion time of 64 days with the quickest being 21 days and the slowest being 201 days.  As you can see, there is a wide variation in the amount of time that commercial carriers take complete the credentialing and contracting process.  It’s always a good idea to assume the process will take anywhere from 90 – 120 days for each plan application that you submit.

It is important to note that you will not receive in-network reimbursement from an insurance company until you have completed credentialing and contracting.  You will only receive in-network reimbursement for claims with dates of service beginning with the effective date of your contract.  Commercial plans do not typically back date effective dates of contracts.

How can I speed up the credentialing process?

The best answer to this question is ‘Accurate completion of the credentialing application’.  

Accurate completion of the application include 1) Make sure that you use the most recent version of the payor’s forms and fill out each page in its entirety.  2) Make certain to report all malpractice insurance claims and sanctions.  It is tempting to gloss over or omit malpractice claim history data, but remember that during the credentials verification process the insurance company will query the National Practitioner Data Bank (NPDB) which will reveal summaries of all malpractice claims or license sanctions that you have been involved with.  Failure to disclose such details have derailed many applications.  3) Be certain to sign and date of your application in all required places.  4) Attach any and all supporting documents requested by the carrier.  This list of documents can include: medical licenses, malpractice insurance certificate of insurance, diploma copy, board certification copy, and other documents specific to each insurance company. 

Incomplete or inaccurate information along with missing signatures are the leading causes of delays in processing credentialing applications.    

Plan and allow appropriate time

If you are starting a new practice or hiring a new provider for your existing practice, allow an appropriate amount of time to complete your credentialing process.  A safe estimate would be to allow 120 days to complete the process for each of the payor’s that you enroll with.

About nCred

nCred is a leading national provider of insurance credentialing services.  Our specialty is working with outpatient clinics to manage the payor provider enrollment process by providing a complete outsourced solution.  Our outsourced provider enrollment services includes maintaining provider credentialing files, maintaining provider CAQH profiles, managing expiring documents, full support for any payor credentialing matter, and access to the nCred Portal.  nCred has helped thousands of healthcare providers throughout the country complete the credentialing process with payers in a timely manner.  Learn more about us and what our clients have to say about our services.  Give us a call today at (423) 443-4525 to find out how our services can benefit your organization, or request a proposal for your credentialing needs.