Starting your own medical practice is an exciting process but may seem complicated from the get-go: finding the perfect location, setting up your staff, 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.
Step-by-step Medical Credentialing
- Obtain a Tax ID from the IRS. An accountant or lawyer can give you the appropriate information to complete the application.
- 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.
- Register for a bank account under the legal business name.
- Search for a location to open your practice.
- Obtain Malpractice Insurance.
- Speak with PrognoCIS Credentialing Department to start the credentialing and contracting process.
- A contract between Credentialing services and the provider.
- Required documents to be submitted by the provider to the Credentialing service.
- Submission of the applications and letters of intent to insurance companies by the Credentialing service.
- The Insurance company begins the credentialing process, obtains the necessary contracts. The provider then becomes effective and in the network.
Comprehensive checklist of everything you need to bring to qualify for credentialing:
|Documentation for Proof of:||MD/ DO||NP/ PA|
|Medical School Degree||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|
|Explanation of Any Malpractice||X||X|
|Any Other Certifications (CPR, CMEs, BLS, etc)||***||***|
*For Non-US Educated Only, Practicing in the U.S.
** If State Requires
*** Not Required But Nice to Have for Credentialing
Important: You can’t 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, you avoid financial burden by being 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 located.
- You have your DEA number.
- You 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.
Do not 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 Assistants as well.
The next likely step after being credentialed 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 alert you about credential renewal and provide additional assistance along the process.
If your credentialing 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.
If you a Healthcare Provider who is tired & frustrated with dealing with all of the paperwork and processes to become in-network with insurance companies, Let our team of experts at PrognoCIS help you!
PrognoCIS delivers credentialing services that streamline the whole process of opening your own medical practice.
Why choose us to take care of your credentialing needs?
- Let us reduce your stress and save you time by managing your Contracting, Credentialing, and Provider Enrollment needs!
- Our team is both knowledgeable and experienced in commercial insurance credentialing, Medicare & Medicaid provider enrollment, and contracting for numerous specialties all over the US, including Hawaii!
- Our staff is professional, friendly, and always responds promptly, keeping you informed throughout the entire process.
- We keep you informed by sending out bi-weekly updates which allow you to see at a glance what the status of your credentialing applications for each network is.