Credentialing 101

Setting up private practice billing can be an intimidating process, especially if you aren’t sure where to start. The first step of the process is always credentialing with insurance companies so that you will appear on their website, in their brochures and in their patient information booklets as a qualified provider. 

Why is Credentialing Important?

If you are not credentialed with a certain insurance provider, you will need to bill the company as an out-of-network provider. Many times, insurance companies will deny these claims and the patient will be stuck with the bill. Most government-based insurance companies like Medicaid, Tricare and Medicare will not pay for any out-of-network services. Practices without credentials will not be able to attract as many patients and might lose patients due to steep out-of-network bills. 

The Basics of Credentialing

The credentialing process typically takes from 90-120 days. Before you get started, make sure that you have the following in place:

  • A separate tax ID number for your practice
  • Malpractice insurance
  • An NPI number
  • A state license for the state you are operating in
  • Knowledge of your taxonomy code if you plan on treating Medicare and Medicaid patients
  • A profile on, a very common credentialing database that most major insurance companies look at
  • A practice location and address

When you are ready to begin the credentialing process reach out to Vetters Enterprises for assistance in managing all the nitty gritty details, or start by contacting the insurance companies that you want to be credentialed with to get applications. Always review contracts before you sign them so that you are familiar with the documentation standards, claim submission standards, appeals processes, free schedules, CPT codes and diagnosis codes. Once you are an approved and credentialed provider with an insurance company, you will gain access to their online provider website. Online tools are a great way to keep track of claims and appeals as they occur.

Need More Assistance?

There’s no denying that the credentialing period is a daunting and lengthy one, which is why Vetters Enterprises is here to help! Looking for a way that your practice can alleviate the stress of having to go it alone? At Vetters Enterprises, we’ll manage everything and take care of all the nitty gritty details during your credentialing period, so that you can get back to what is most important – taking care of your patients.

Vetters Enterprises specializes in practice management, revenue cycle optimization and private practice business support. We can also perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

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