Insurance Credentialing. . .HELP!

Hi there. I recently accepted my first NP job in a small pediatric office. Luckily there billing company takes care of all credentialing. As I replied to a similar post previously, just getting them the necessary documentation and signing all the applications has been very time consuming and overwhelming. I would not suggest taking on this endeavor on your own. Also, the signed employment contract was one of the documents required by most insurance companies. It seems like it would be impossible to get credentialed without that.

The billing company did say that lots of NPs have their charts co-signed by MDs and bill under the MDs credentialing. My practice did not want to do that, fearing that it isn't completely legal/ethical. Some insurers such as BCBS don't credential NPs unless they are independent practitioners, so there isn't any credentialing involved, you just bill under the MD.

I accepted this job around June 1st. I am currently credentialed with only about 1/2 the necessary ins. companies. It really is a lengthy process.

If you aren't committed, there is no harm in continuing to look even if you decide to attempt to work through the credentialing process.

I would agree with the above. Everywhere I've worked the practice took care of the credentialing. Most practices don't consider it a big deal. For Medicare you can hold billing and submit it once you get your NPI. For most insurance practices they don't credential non physicians so you just bill under the physician. Even for physicians there is a lag period. Most practices just count it as the cost of doing business.

David Carpenter, PA-C

yep same for me too, the practices where I have worked have taken care of all of the credentialing paperwork.

the job I just took has a person who is solely responsible for all the credentialing for clinicians. I only had to sign off on a few forms.

I would continue to look

I would have the office help you at the minimium. I'm the one who posted about medicare. The office manager/biller and I sat down and did the CAQH and medicare together and that we were wouldn't miss anything and get it right. Everything has gone smoothly except Medicare which I hope will be okay this time around. I would ask for help and if they won't I would definately look elsewhere. It sounds like as far as completing credentialing and starting employment we are in the same boat. There are also short forms to fill out with each company, but they aren't much, b/c usually at least in my area they get the rest from CAQH. I'm credentialed with everyone, but Medicare at this point it's been a couple months.

Credentialing is going to be a bit different from state to state as far as who you can credential with and what their requirements are.

I happen to believe we all should be billing under our OWN credentials and not the physicians. It's one of the things that keeps us invisible.

Credentialing can be a pain. Often times there will be someone in the office to help, but if it's a small office there is going to be less help. CAQH is relatively easy. The info that you needed for them, is what you will need for everyone. In our state (WA), there is a state provider application we use for ALL insurances...I just make copies of the parts I can.

Medicare and Medicaid are a bit different, but I'm sure that surprises no one. The basic info is the same however.

It does take a while. I often advise NPs to start this ASAP when opening their own practices. Keep copies of EVERYTHNG and keep a spreadsheet of when things were sent, the person you need to contact, when you should be following up etc.

Most of all...breathe.

Best wishes,

BarbaraNP

Ok, so since I posted I was able to complete the CAQH form and there are a few companies accessing that as far as I know. The office has been alittle bit of a help, but the bulk of it is on me. The office manager basically gave a me spreadsheet of their insurances to call or contact to get info for credentialing. I have been doing this and am probably most of the way through. It's so exhausting though! This is a very small office, so I am not getting a ton of help, and I am alittle bothered by this.

It's sounds like, until all my credentialing through, the physician could sign off on my charts in the meantime so that the practice gets paid? Am I getting this right? And that is legal?

Thanks for the help everyone!

Is it the same for other insurance besides Medicare? The office is a pediatric practice, so I don't think Medicare will be an issue.

Is it the same for other insurance besides Medicare? The office is a pediatric practice, so I don't think Medicare will be an issue.

Not so fast Violet29:wink2:, I work in a peds practice and needed to be credentialed with Medicare. I believe some disabled children are eligible for Medicare.

Oh, interesting! Well, the "office manager" gave me a list of insurances they are working with, and Medicare was not on it, so I'm assuming I don't have to be. I will have to ask that question now though.