Wiki Credentialing Time - KPI

[poppyt]

What would be a good, estimated amount of time it would take to do the payer applications for a new provider? For all the mainstream payers, MCR, MCD, BCBS, Cigna, UHC, Aetna, Humana etc. (not looking for how long it takes the payer to approve) I realize this will depend on different factors; I would like a jumping off point on what is a realistic about of time for my credentialers to complete the application processes.
What would be a good time frame for the re-enrollment/revalidation process?
Thanks for any information and advice.

 

[ckel138]

What would be a good, estimated amount of time it would take to do the payer applications for a new provider? For all the mainstream payers, MCR, MCD, BCBS, Cigna, UHC, Aetna, Humana etc. (not looking for how long it takes the payer to approve) I realize this will depend on different factors; I would like a jumping off point on what is a realistic about of time for my credentialers to complete the application processes.
What would be a good time frame for the re-enrollment/revalidation process?
Thanks for any information and advice.

In my experience, it takes at least a month to 3 months depending on the insurance company, from what Provider reps have told me, Approval committees only meet twice a month and only review 3-5 applications at a time. Considering that there are many applicants, reviewing only 10 applications a month put a long delay in getting approved. Also CAQH does nothing to expediate the process. Each provider really needs to provides your team everything that they have and needs to be active in the onboarding process.

 

[csperoni]

I think the above reply is answering how long for a payor to approve an application. However, I interpret your question as "How long should it take my employee to fill out an application?"
If they are filling out the application and not doing any followup, maybe 30-40 minutes per application? It's been awhile since I've been involved with credentialing, but once you compile all the paperwork required, it is then submitting the same information on different paper/online forms. It's work you want to do, then look over carefully before submission. A wrong digit on the NPI could cause a rejection or other significant delay. I personally prefer someone on my team who might work a bit slower, but with 100% accuracy over someone who can do twice as many, but has errors. Hopefully someone more currently involved in credentialing applications could weigh in.

 

[rthomas@impcna.com]

Since I have many positions in my practice I usually dedicate myself a full 8 hour day to complete applications. Having all the applications and required information you need before you begin is a huge time saver. To help with this I have a questionnaire and spreadsheet that contains everything that the applications require. I give a copy to the provider to gather the info before I even begin. I would be happy to send it to you to use as a reference.

 

[poppyt]

I think the above reply is answering how long for a payor to approve an application. However, I interpret your question as "How long should it take my employee to fill out an application?"
If they are filling out the application and not doing any followup, maybe 30-40 minutes per application? It's been awhile since I've been involved with credentialing, but once you compile all the paperwork required, it is then submitting the same information on different paper/online forms. It's work you want to do, then look over carefully before submission. A wrong digit on the NPI could cause a rejection or other significant delay. I personally prefer someone on my team who might work a bit slower, but with 100% accuracy over someone who can do twice as many, but has errors. Hopefully someone more currently involved in credentialing applications could weigh in.

Yes, I am looking for how long it should take an employee to do the initial applications to start the process. I have not done credentialing in my career; I am not sure what an appropriate amount of time I should expect my team to complete the initial application process for all payers. My current lead in credentialing has said between 12 and 16 hours for one provider/all payers.

 

[poppyt]

Since I have many positions in my practice I usually dedicate myself a full 8 hour day to complete applications. Having all the applications and required information you need before you begin is a huge time saver. To help with this I have a questionnaire and spreadsheet that contains everything that the applications require. I give a copy to the provider to gather the info before I even begin. I would be happy to send it to you to use as a reference.

My current lead in credentialing has said between 12 and 16 hours for one provider/all payers. Does this seem like a reasonable amount of time? I have not done payer credentialing in my career.

 

[csperoni]

Yes, I am looking for how long it should take an employee to do the initial applications to start the process. I have not done credentialing in my career; I am not sure what an appropriate amount of time I should expect my team to complete the initial application process for all payers. My current lead in credentialing has said between 12 and 16 hours for one provider/all payers.

If that 12-16 hours includes first compiling all the information (licenses, CAQH info, malpractice history, etc) from the provider, and then filling out multiple applications, that seems very understandable. I had estimated 30-40 minutes for each application (assuming someone was handing them a folder with all the info). Obviously if you are applying only to Medicare and BCBS, it would take less time than credentialing for 20 payors.

 

[rthomas@impcna.com]

My current lead in credentialing has said between 12 and 16 hours for one provider/all payers. Does this seem like a reasonable amount of time? I have not done payer credentialing in my career.

I agree with csperoni, 30-40 mins per application. I recently credentialed a physician with 14 payors and it took me about 10 hours but I had everything I needed.