For healthcare providers, obtaining credentialing with an insurance organization is a crucial step toward joining payer networks and receiving reimbursement for facilities. However, while the process is important, it is not a rapid one. Let’s find out How Long it takes to Get Credentialed With Insurance Companies & why? The majority of people can expect credentialing to take between 90 and 120 days, and frequently up to 180 days. Depending on the payer, speciality, documentation quality, and the responsiveness of third-party verification sources, timelines can vary significantly
Understanding The Credentialing Timeline
The credentialing method contains multiple structured steps, each with its own timeline. On average, the complete process can take 12 to 24 weeks.
Preparing documentation (1 to 2 Weeks)
The initial stage includes gathering all the documents needed for the application. Providers must create a detailed checklist to prevent omissions. General documentation includes:
- Personal and expertise details.
- Education history and diplomas.
- Clinical licenses and board certifications.
- Work history with dates and responsibilities.
- DEA registration.
- References.
- Background disclosures.
Precision is crucial. Missing or incorrect information can addresses delays later in the process. Providers using credentialing experts or software can potentially streamline this phase.
Submitting Application (1 to 2 weeks)
After documentation is ready, the next phase is completing and submitting applications to the chosen insurance companies. This involves:
- Entering and reviewing personal and professional data.
- Completing multiple insurance-specific applications.
- Proofreading for accuracy.
- Submit electronically or through the payer’s preferred process.
- Recording submissions and responding to payer requests.
Utilizing credentialing software or working with a credentialing facility supports minimizing errors and timely follow-ups.
Primary Source Verification (4 to 6 Weeks)
One of the longest stages is Primary Source Verification, in which insurance companies contact:
- Clinical schools.
- Licensing boards.
- Training institutions.
- Past employers.
They verify that the provider’s credentials are authentic and current. The timeline is largely based on how quickly these institutions react. Providers cannot expedite this stage, but complete and accurate documentation supports preventing re-requests and further delays.
Insurance Company Review (4 to 8 Weeks)
Once verifications are complete, the insurer starts a depth review. This involves:
- Assessing qualifications and experience.
- Ensuring compliance with payer standards.
- Conducting background and malpractice checks.
- Confirming documentation meets internal quality needs.
Some payers complete reviews quickly, while others need multiple layers of internal approval.
Board Or Committee Approval (1 To 2 Weeks)
Most insurers permits a credentialing committee to formally approve an application. These committees often hold meetings monthly or bi-monthly, so the time affects how fast an application moves forward. The committee determines all findings, details issues, and estimates whether to approve, refuse, or request more details. This phase typically adds one to two weeks to the overall timeline.
Contracting And Enrollments (2 to 4 Weeks)
Once approved, the deliver gets a contract outlining the terms of participation in the insurer’s network. After reviewing and signing the agreement. The insurer updates its system to officially enroll the provider. This ending phase generally needs 2 to 4 weeks. In total, the complete credentialing method generally takes 12 to 24 weeks (3 to 6 months).
How Can Providers Speed Up The Credentialing?
Although providers cannot control the insurer’s internal processes, they can potentially lower delays by preparing thoroughly and working proactively.
Streamline Documentation
- Maintain all credentials, licenses, insurance certificates, and identification in one organized file.
- Submit documents in standard formats such as PDF.
- Double-check application accuracy before submission.
- Use digital submission whenever possible.
- Adhere to the instructions to ensure receipt and status.
Conduct Pre-Credentialing Reviews
- Use detailed checklists to ensure nothing is missing.
- Perform mock credentialing reviews to identify weak spots or incomplete areas.
- Verify that all expiration dates are current.
Work With Credentialed Professionals
Third-party credentialing facilities or managed service organizations (MSOs) can potentially shorten timelines by controlling forms, ministering applications, and communicating with payers. If you feel any issues, address your expert right away. This permits providers to concentrate more on individuals rather than on administrative tasks.
Sustain Strong Payer Relationships
- Communicate daily with payer credentialing teams.
- Notify insurers of any changes in address, licensure, affiliations, or practice details.
- Establishing rapport with payer representatives can make follow-ups smoother and faster.
Final Thoughts
Credentialling can feel radical, unpredictable, but understanding the method supports providers in managing expectations and preventing delays. By ready complete documentation, staying organized, and engaging credentialing support when required, providers can potentially enhance their chances of moving through the method as efficiently as possible. Book your schedule with DocVaz medical billing experts to be credentialed with insurance companies.
