Credentialing Your Medical Practice For Provider Enrollment

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Credentialing Your Medical Practice For Provider Enrollment

Starting your own practice is an exciting process that may seem complicated from the get-go: finding the perfect location, building your brand, and achieving profitability. One of the most important first steps on the road to financial success is fulfilling your provider enrollment—becoming affiliated with insurance companies so that you can receive third party reimbursement. Credentialing is required for in-network payment from insurance providers. PrognoCIS delivers credentialing services that streamline the whole process of opening your own medical practice.

Here’s what you need to do, step-by-step:

  1. Obtain a Tax ID from the IRS. An accountant or lawyer can give you the appropriate information to complete the application.
  2. Register for a Type 2 National Provider Identifier (NPI). Type-1 NPI’s are for providers, Type-2 NPI’s are for businesses. PrognoCIS Credentialing can assist with getting you settled.
  3. Register for a bank account under the legal business name.
  4. Search for a location to open your practice.
  5. Obtain Malpractice Insurance.
  6. Speak with PrognoCIS Credentialing Department to start the credentialing and contracting process.

A contract is then written between PrognoCIS Credentialing and the provider. Submit all required documents to PrognoCIS Credentialing. PrognoCIS submits the applications and letters of intent to insurance companies. The insurance company begins the credentialing process, obtains the necessary contracts. The provider then becomes effective and in the network.

Here is a comprehensive check list of everything you need to bring to qualify for credentialing:

Documentation for Proof of:                    MD/ DO                      NP/ PA
Medical School Degree                        X                            X
Internship                        X
Residency                        X
Board Certification                        X                            X
The Educational Commission for Foreign Medical Graduates / Fifth Pathway*                        X
Drug Enforcement Agency (DEA)                        X                          **
Controlled Dangerous Substance License**                        X
Curriculum Vitae (YY/MM Format)                        X                            X
State Medical License                        X                            X
Council for Affordable Quality Healthcare                        X                            X
Driver’s License                        X                            X
Malpractice Certification                        X                            X
Explanation of Any Malpractice                        X                            X
Any Other Certifications (CPR, CMEs, BLS, etc)                      ***                          ***

*For Non-US Educated Only, Practicing in U.S.
** If State Requires
*** Not Required But Nice to Have for Credentialing

Remember: You can’t even apply for credentialing until you have an Employer ID Number (EIN), business location, and a phone/fax number. Once you have these things, you’re on your way to becoming profitable. Make sure that when you open your doors to start seeing patients that you are avoiding financial failure and are fully credentialed. Our collaborative efforts on all of the above steps are how we have helped each other be prepared for the credentialing process. There are a few other things you will need to provide in this step. You will have to prove you are licensed to practice in the state you are locating, have your DEA number and are covered by malpractice insurance or have a personal coverage policy accepted by insurance networks. So, get these lined up as quickly as possible and add them to the required name, address, and phone/fax numbers. Don’t forget: It’s not just MDs and DOs who need to be credentialed. Any individual who signs off on any portion of any billing content must be credentialed. This means Nurse Practitioners and Physician’s Assistants as well.

The next likely step after being credentialled is to pick the EHR your practice is going to use. If you’ve chosen PrognoCIS to assist in the credentialing process, you might be pleased to find out we are also an award-winning EHR. There are many benefits to having your credentialing service provider and your EHR under the same roof. Credentialing usually needs to be renewed every two to three years. Since your EHR is already in regular contact with the insurance providers that you connect with for billing purposes, PrognoCIS can to alert you about credential renewal and provide additional assistance along the process.

If your credential service and your EHR are different companies, you have to wait for notification from the provider, gather the identifying material, send it back to the provider and wait for them to process it—all while awaiting payment.Make sure you are climbing the ladder to success. With PrognoCIS Credentialing and PrognoCIS EHR you can make it to the top! Fill out the form on our contact us page to get started with PrognoCIS Credentialing today.