Physician credentialing is a critical process through which healthcare providers can access patients and receive reimbursement. The question that many providers and administrators pose is how long does physician credentialing take. The duration of the process differs greatly depending on a variety of considerations, but is usually between 90 days and 180 days or more. This is the ultimate guide, where we will subdivide the typical sequence of credentialing, discuss the common reasons behind the delay in credentialing, and eventually provide valuable ideas on how to speed up credentialing process in physicians and groups.
What Is Physician Credentialing?
Physician credentialing involves the official confirmation of a medical practitioner in terms of educational qualification, training, licensure, and certification, as well as malpractice record and work experience. Hospitals, medical groups, insurance payers, and others provide credentialing to guarantee the professional standards and regulatory needs of providers.
In the absence of credentialing, physicians cannot legally participate in networks, submit claims to insurers and accept patients in facilities. Thus, it is crucial to be aware of the credentialing timeline and its acceleration into a smooth practice operation, better revenue cycle management, and continuity of patient care.
Key purposes of physician credentialing include:
- Patient Safety: Credentialing prevents death and harm on patients through the assurance that solely qualified and vetted professionals render medical care. This will reduce medical errors and protect the health of patients.
- Enhancing Healthcare Standards: It is the measure that providers uphold professional standards prescribed by hospitals, insurance companies, and regulatory accreditors to enhance uniformity and quality of care services.
- Regulatory and Compliance Requirements: Credentialing assists healthcare organizations meet federal, state laws and accreditation standards, payer policies to minimize the possibility of fraud, abuse, and liability.
- Verification of Professional Competence: Credentialing by direct communication with primary sources (medical schools, licensing boards, and certification agencies) verifies that the medical practitioner qualifications and credentials are valid.
How Long Does Physician Credentialing Take?
Physician credentialing usually takes between 60 and 120 days, and sometimes it may take up to 150 days and beyond, depending on the following survey factors like the payer to which the physician is bound, the state requirements and the completeness of documentation submitted. To achieve this, credentialing timeline can be different in different organisations, opine because they have different verification procedures and administrative processes.
A professional breakdown of a typical credentialing duration by type is given below:
- 60 to 90 days Commercial Insurance Plans (e.g., Aetna, Cigna, UnitedHealthcare):
- Medicare: 30 to 60 days
- Medicaid: 60 to 90 days
- Hospital Privileges: 90 to 120 days
- Big Health Systems and Networks: 90 to 150 days.
Why Credentialing Is So Time-Consuming?
The time involved in credentialing is lengthy owing to an inevitable number of challenges and complexities involved. The following are the Key reasons why delays plague physician credentialing:
- Incomplete/Inaccurate Documentation: When information is included but is not available or blank, incomplete (such as licenses not posted or work history not furnished), and/or is inconsistent, corrections are requested several times, making progress slow.
- Verification Bottlenecks: The interaction needs primary source verification of all credentials, such as education, licenses, board certifications, and work history. These checks are based upon third parties or external organisations such as medical schools, licensing boards and certification agencies, which in most times take weeks or months to reply to the same.
- Payer-specific and State-specific Requirements: Insurance payers, as well as states, may have different documentation criteria, submission procedures and regulatory requirements. Avoiding such variations can frequently cause mistakes, rework and delay.
- Absence of Timely Communication: Applications become stalled because providers or credentialing teams are not responsive and prompt when requested to provide follow-up on an application due to such delays.
- State Licensing Differences: State speed and methods of licensure, including handwriting mails or faxes, contribute to delays, particularly when it comes to providers with practice in more than one state or hospitals.
- Regulatory/ Policy Changes: Payor policies or federal/ state regulations are frequently updated, which necessitates the credentialing process to be regularly restructured, which may cause, at times, temporary delays.
Ways to Speed up Physician Credentialing
A healthcare organisation or provider may implement some of the practical approaches in shortening physician credentialing and credentialing delays; given the long time credentialing can take. The following methods increase efficiency and minimise administrative overhead and optimise provider onboarding:
1. Start Early and Be Proactive
Start the credentialing process at a very early time before expected date of the expected start date. Timely submission of applications interferes with the schedule of patient care since it provides sufficient time to solve unforeseen problems or paperwork. Establishing in-house timelines of every phase of credentialing keeps the process going and minimises procrastination at the very end.
2. Make Proper and Full documentation.
An effective way to strengthen any given application is first of all to make unconditional checks on all the necessary documents before filing them and including them are licenses, board certifications, records of education, the history of work, and malpractice information. Credentialing delays are caused chiefly by incomplete or incorrectly filled applications. Checklists of provider credentialing or credentialing software can be used to make sure that all documentation has been covered.
3. Centralised credentialing software.
Implement data tracking, submission, and primary source verification credentialing management systems that are automated. Here platforms frequently offer status notifies, expiration notices, workflow automation, as well as a reduction in errors. Applications like CredentialStream, Superio Health, etc. could reduce processing time by a large margin and speed up credentialing ptocess.
4. Allocate Specific Credentialing Personnel
A dedicated credentialing unit that entirely deals with the applications and follow-ups makes sure that the information requests, together with the verification status, are responded to promptly. Smaller practices may also receive value by outsourcing physician credentialing services to do the credentialing, who have knowledge and well-established payer relationships.
5. Apply for the opportunities at a time
In sub adding applications to multiple payers or hospitals, do not submit them in series, but submit them simultaneously. This method builds upon documentation and verification steps by taking into consideration overlapping steps, which minimise cumulative processing time.
6. Keep constant follow-up and communication
Regular contact with credentialing agencies, insurers, and hospitals is used to get any pending requests taken care of in time. Proactively follow up status of applications and respond immediately to dismay or further answering requirements to avoid bottlenecks.
7. Use Professional Networks
Establishing relationships with payer contacts or credentialing committees may at times speed up credentialing by allowing quicker requests and exposition, especially with speciality providers or small payers.
Conclusion
The credentialing process of physicians takes a time average of 3 to 6 months, depending on the credentialing type, the responsiveness of the payers and the completeness of the applications. Timeframes for credentialing are highly varied, with delays of up to half a year for internal checks through external checks and committee work.
It is possible to make the process much more straightforward by becoming the owner of the credentialing timeline and taking a proactive approach to employ clever strategies. Exclusively through centralised systems like CAQH, assigning credentialing officers, and keeping active communication channels with the payers are some of the most effective means of speeding down the credentialing as well as curbing the wait time and reducing physician practices and evaluating physicians who invest in best practices of credentialing results in faster participation in the networks, quality inflow of revenue and quicker patient delivery.
Close monitoring of the progress of credentialing statuses and planning are prerequisites in the present sophisticated healthcare setting, whereby timelines in credentialing remain a burdensome factor to healthcare professionals.
FAQ - People Also Asks
What is the duration of the credentialing process of a PA?
Medical credentialing is a procedure that cannot be omitted, but is complex because it may take up to 90-150 days to be accomplished. Although multiple factors might drive the timeline, healthcare providers can take several proactive actions that help in reducing the delays and delivering a smoother experience in credentialing.
How is credentialing done?
The process of credentialing starts with the gathering of needed documents and data, where the essential documents, such as educational certificates, licenses, completion of residency documents and history of work experience, are obtained. The providers must also show notarised identification issued by the government, malpractice history and in some instances a criminal background check.
How come it takes so much time to get credentialed?
One of the primary reasons why credentialing takes a long time is its tiring nature. All aspects must be well-certified and examined for the qualification of a provider.
How does credentialing have a lifecycle?
After a new provider who has just presented to an organisation is credentialed, onboarded, and practising in the hospital or system, they also receive a modified credentialing process, which occurs around two years later.