Credentialing Tips: AVOID Negative Financial Impacts on Your Practice

The payer enrollment process is unwieldy and can have a serious impact on your revenue cycle.  However, it is a necessary task that, although it can be painful, is critical to the health of your practice.  Either the delayed enrollment of a new provider or missing the re-credentialing of an existing provider can have negative financial impacts on your practice.

 Here are some best practice credentialing tips:

• Physicians should re-verify CAQH (Council for Affordable Quality Healthcare) quarterly

• Stay on top of license renewals

• Stay on top of CLIA (Clinical Laboratory Improvement Amendments) renewals

• Stay on top of malpractice insurance renewals

• When in doubt, call the payor to find out whether they need something updated

• New physicians joining your practice – the more lead time the better, at least 90 days

• Remember to notify payors of address changes or new locations

• Keep a schedule in accordance with your state’s recredentialing requirements so that you are not relying on receiving recredentialing notices from other parties, but rather can be proactive in ensuring you are satisfying all requirements

• There are a few very good credentialing software programs available. Depending on your needs and the size of your practice, consider investigating this option.