Q & A

What is Credentialing?

Also called physician, medical or provider credentialing -  is a lengthy detailed process of gathering pertinent information in order to review and verify qualifications consisting of career history, child and criminal backgrounds, education, residency, training, licenses, malpractice and any other specialty certification.  We gather this information in preparation for the credentialing process in order to complete the necessary payer/provider enrollment forms efficiently.

What is CAQH and what does it stand for?

CAQH (Council for Affordable Quality Healthcare) is basically a provider portal where all insurance companies

go to retrieve information about your employment/work history for credentialing purposes. (Basically one huge application in one location for all insurance companies to see ...with your approval of course). 

How Can I get a CAQH#

Once you get your NPI#, contact us so that we can get the CAQH# for you. We do charge for setting up your CAQH application and portal; however, give us a call so that we can help you do it yourself for free.

What is a NPI number?  (Type 1 and Type 2?)

NPI  (National Provider Identifier) is a unique 10-digit identification number issued for health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).  Basically, just like your social security number identifies each person to the government, well this number identifies you to the health care world.  The NPI has replaced the unique provider identification number (UPIN) as the required identifier for Medicare services, and is used by other payers, including commercial health care insurers.  If you do not have this identifier, let us know and we will send you the link to get one.  It is fast and easy!

• Type 1 NPI – an individual clinician is eligible for only one NPI

• Type 2 NPI – Health care providers (groups, hospitals, nursing homes, corporations formed where an individual incorporates him/herself can get a Type 2 NPI)

For ex:  If a clinician works for a group, then that clinician would have a Type 1 NPI identifying themselves AND a Type 2 NPI identifying the group.

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How long does it take to get credentialed?

The entire credentialing process can take anywhere from 90 to 120 days to complete (per plan). If there is a petition process or appealing involved, it can take up to 220 days. If you have been credentialed with insurance companies in the past and you currently have an "active" status, the process may take 30 to 60 days to “link” your active status to your group or solo/private practice.  Through constant nagging on our part, we have had experience getting clinicians “linked” as early as a week in some cases.   

Why does it take so long?

Insurance companies all seem to work with this time frame to verify and process your information. Although the time frames can vary depending on the company, it is very common for “feet dragging” to occur during this process.  Yes, insurance reps are probably overworked and are responsible for thousands of applications daily; however, we found through our experience, we know the” ins and outs” of staying on their heels!  Call us “nagging gnats” if you want, but dealing with some insurance reps, it surely gets the job done.  It is also very important to make sure you complete your forms accurately and sent to us in a timely fashion...something as simple as not explaining your gaps regarding your work history, can prolong the process.