Credentialing

telemind

Contributor
Messages
12
Best answers
0
As a group practice we would like to know how long it takes to credential a Nurse Practitioner with most major commercial insurances?
  • What is the quickest way for us to get them credential under our group?
  • Would it speed up the process if they have been previously credentialed with that specific commercial insurance?
  • Meanwhile pending to be credentialed are they allowed to start practicing and bill under our Supervising MD? Or are we to hold all the billing while on “pending status” until approval comes in and then back bill for the patients seen?
  • Is this different per insurance?
 

Chelle-Lynn

True Blue
Messages
706
Location
Modesto, CA
Best answers
0
What is the quickest way for us to get them credentialed under our group?
This will depend on the carrier. Most national carriers either have an online credentialing process (example: Medicare with PECOS) or use a nationally know vendor such as CAQH. In most cases there is not a "quick" way. All providers must complete the credentialing process and there are little to no short cuts for the time it takes to complete this process.

Would it speed up the process if they have been previously credentialed with the carrier?
In some cases yes, this will help with the timeframe as some of the verification such as education will already be completed. However most carriers have credentialing boards or committees that the application will need to go before to receive final approval before being made active. This may affect how quickly the carrier is able to process the newest application depending on their schedule for meeting and the volume they have to review.

While pending credentialing are they allowed to start practicing and billing under a supervising MD?
Using the Medicare rule of incident-to rule; this provides an exception and permits reporting of services performed by personnel under the name of a credentialed physician, if requirements are met. This rule is most commonly used to report the services of NPPs under the name of a licensed and credentialed physician.

The regulations contain elements that must be met to fall under this category:
1. A credentialed physician must initiate the care of the problem that is to be managed by auxiliary personnel. This includes performing the initial E&M service for that problem, and establishing the diagnosis and plan of care.
2. The credentialed physician you are billing under must provide direct on-premise supervision of the personnel providing the incident-to services.
3. A credentialed physician must be actively involved in the ongoing care of the patient. When subsequent services are rendered by NPPs, satisfying this requirement is usually defined by the state licensure rules applicable to physician supervision of NPPs. It may mean the physician must see the patient every third visit (as an example), or simply reviewing the charts for non-complicated encounters.
4. Both the credentialed physician and the NPP providing the actual service must be employed by the group entity billing for the service. When the physician is a sole practitioner, the extender must be employed by the physician.
5. The services performed by the NPP must be those usually performed in the office setting.


Is it different per insurance?
Yes. While each carrier follows a list of basic steps to process their credentialing applications, the timeframes may vary depending on staffing, expertise, etc. As always the sooner you start the credentialing process the happier your office will be.
 

Henson65

Networker
Messages
44
Best answers
0
If you have group agreements with any carriers, all you have to do is get ahold of your provider rep and add the NP to your group contract...they can do this in a matter of minutes.
 

telemind

Contributor
Messages
12
Best answers
0
Thanks for the answers guys but this seems to contradict the first poster. Is it minutes or they go through a lengthy credentialing?
 

Chelle-Lynn

True Blue
Messages
706
Location
Modesto, CA
Best answers
0
It depends on the carrier and their requirements. Based on the carriers requirements it can be an easy addition or a lengthy process. It may also depend on whether or you adding the provider as ordering/referring only versus a full credentialing process.

In 2018 we saw a increase in the requirements needed for credentialing NPP, but as noted this is carrier dependent.
 
Top