Wiki NP Credentialing Help

[AthensCoder]

Hello,

We are in the process of interviewing nurse practitioner's. My administrator has never done credentialing nor have I. So I was hoping maybe someone can point us in the right direction on where to start. We are located in Georgia.

Does anyone have a list of which insurance companies will credenial NP's?

I know Medicare, Medicaid, and Aetna will. I'm not sure on the other major insurance carriers.

Any assistance will be greatly appreciated.

Thank you

 

[cstadlman]

We are located in South Dakota and most insurance companies will credential NPs. Make sure when you to credential them that they get credentialed as a CNP and not as a specialty. There have been times are NPs have been marked as specialty due to NPs rather than Family Medicine and patients were paying specialty copays instead of professional copays.
Not sure if that helps much. We put a list together of all the major insurances (ran from our EMR) and started with them. Great to find a contact from the insurance companies as well. Most can be done online.

 

[csperoni]

Great advice above from @cstadlman. I would just add to start the credentialing the moment contracts are signed and not wait until start date. This applies to any clinician, not just NPs. In order for them to be most productive, they need to be participating with all insurances that the practice participates with by the time they start seeing patients. This is usually not possible unless starting very early. If by the time your NP is ready to see patients, credentialing is not completed, your front desk schedulers will need to guide appointments accordingly.

 

[AthensCoder]

We are located in South Dakota and most insurance companies will credential NPs. Make sure when you to credential them that they get credentialed as a CNP and not as a specialty. There have been times are NPs have been marked as specialty due to NPs rather than Family Medicine and patients were paying specialty copays instead of professional copays.
Not sure if that helps much. We put a list together of all the major insurances (ran from our EMR) and started with them. Great to find a contact from the insurance companies as well. Most can be done online

Thank you for the information..We are a gastroenterology specialist. So in this case we would want to credential as a specialist, correct?

 

[AthensCoder]

Great advice above from @cstadlman. I would just add to start the credentialing the moment contracts are signed and not wait until start date. This applies to any clinician, not just NPs. In order for them to be most productive, they need to be participating with all insurances that the practice participates with by the time they start seeing patients. This is usually not possible unless starting very early. If by the time your NP is ready to see patients, credentialing is not completed, your front desk schedulers will need to guide appointments accordingly.

Thank you for the response. That is my hope that we can get this ball rolling asap before her start date.

 

[csperoni]

Thank you for the information..We are a gastroenterology specialist. So in this case we would want to credential as a specialist, correct?

Yes, your NP should be credentialed the same as their supervising/collaborating physician. So for GI, credentialed as specialist.

 

[TThivierge]

Hello
You can go to this website which most payers have access to and ensure their professional data is listed there and add your office location . Each provider is given ID # and password for CAQH. Welcome to the CAQH Provider Data Portal formerly known as CAQH ProView. CAQH Provider Data Portal eliminates duplicative paperwork with organizations that require MD,DO, NP, PA professional and practice information for claims administration, credentialing, directory services, and more. Help reduce inquiries for your administrative information and save even more time by keeping your profile complete and up-to-date. Ensure that the healthcare organizations you are in contract with. It may need your payer credentialing contracts completed and signed by provider then added to this website.
I hope this data helps you
Lady T