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Two steps to contracting and credentialing

June 7, 2018 | Holly

Credentialing a provider with the pay sources (insurances) is a way to let them know who the provider is, and what services are being offered. Medical or behavioral healthcare providers who are intending to get claims paid by insurance companies will want to complete this first step – credentialing. You will need to submit provider information such as licence, tax identification number, NPI number, date of birth. Generally, the insurances will not pay providers who are not on record as credentialed with them. This may take a month or longer, so it is important to start early.

If you do not intend to contact with the insurance, the credentialing still needs to be completed. Once your credentials are approved, the insurance will add you to their list of providers who are offering services in the community. They may then offer you a contract, or respond to your request for a contract, but this is a separate phase. This phase may take longer, sometimes as much as three months. Until contracting is completed, you will be out of network with that insurance company. Some plans do offer their members out of network benefits, but usually at lower rates. So again, it is important to begin credentialing and contracting early if you plan to receive payment from insurance companies.