Episode 6: Credentialing And Contracting

There always seems to be a great deal of confusion about credentialing and contracting. In this episode, I'll talk you through the differences and give you some pearls on navigating the "system." Really--it is very straightforward. 

• If you are all Cash Pay--you don't need to worry about being either credentialed or contracted.
• Credentialing is the equivalent of the good housekeeping seal of approval. It means that the insurance company "recognizes" you. It has absolutely nothing to do with money--meaning how much the insurance company is going to pay you. 
• You need to be credentialed regardless of whether you plan to be in network or out of network.
• You can use CAQH Pro to apply for credentialing with multiple insurers--and it's a free service. Here the link: https://proview.caqh.org/Login/Index?ReturnUrl=%2f
• Get all of your documents together before you even start--this is the part that takes the longest time. 
• Here's a list of the documents/info you need to get started:
  • License to practice
  • DEA and CDS certificates
  • Education and training 
  • Board certification
  • Work history
  • Malpractice history (NPDB)
  • License sanctions (NPDB)
  • Medicare/Medicaid Sanctions (NPDB)
  • Hospital privileges
  • Current malpractice coverage
• If you are going to be out of network, you do not need a contract. You only need to be credentialed.
• If you want to be in network, you need to have a contract.
• Many insurers will allow you to go through the credentialing and contracting process simultaneously
• Credentialing and Contracting take a long time--way longer than you think (like 3-6 months)--Plan ahead

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