Credentialing 101 For Your Private Practice

So, you want to take insurance payments? Or do you think you might possibly want to take insurance payments at some point down the road? 

Whether you’re sure right now or not, you’ll do yourself a favor by learning about credentialing in the clearest and least intimidating way possible. 

Not sure what that credentialing really is? Or does what you do know sound like a hassle you don’t want to take on?

To be sure, insurance panel credentialing and Medicare credentialing have their challenges. However, don’t assume that. With a little education and expert support, you will have what it takes to get the job done.

Now, to start, it’s always good to answer some basic questions first:

What is Credentialing Exactly? 

Simply put, credentialing is a process by which you establish your qualifications as a legitimate, licensed professional and submit them for assessment to health plan networks.

Why bother? Insurance plan credentialing is essential if you want to provide care for patients who are insured as an in-network provider.. In other words, if you want in-network  benefits to pay for your work, credentialing with local insurance companies matters. It is vital to generate a bill-pay process that will support your aim to create a lasting and profitable healthcare revenue cycle for your practice.

Is Credentialing Hard to Do?

It doesn’t have to be the chore it’s purported to be! Still, you need a wealth of user-friendly information and experienced guidance. Fortunately, you’ll find those here.

With an open mind and commitment, you’ll soon organize and obtain the credentials necessary. Moreover, you’ll have the skills required to build a revenue cycle that brings you peace of mind and the profits you deserve.

You should know: 

 1) Just as license requirements vary from state to state, so do credentialing requirements from one health plan to another. Some have paper forms to return some have an online process to adhere to. 

2) Attention to health plan constraints and guidelines is paramount. Knowing your client base well is vital. This will help you accurately pair your own services and the health plan’s reimbursement offerings. Also, being clear about which local insurance companies cover mental healthcare and are most popular is crucial.

Is There Anything I Can Do to Make Insurance Plan Credentialing Less Overwhelming?

Yes! The best course of early action is to get your documentation ducks in a row. You want to be ready and able to provide whatever the company requests. A quick-start guide can make things so much easier and insurance panel requirements much less intimidating. Fortunately, we have such a guide. Our list of actions suggests the following

  • Making yourself a small business entity (and how to do it).
  • Obtaining your Tax ID.
  • Setting up a  business banking account for your payment transfers (EFTs).
  • Obtaining your PLI ( Professional Liability Insurance).
  • Obtaining the required national provider identifier number or NPI (the 10-digit number assigned to by the Centers for Medicare and Medicaid (CMS).
  • And more…

Insurance panel credentialing can take quite a while. Even if you do it all correctly, an initial application’s road to acceptance is often 50-180 business days!  You’ll need to be mentally prepared and patient as you may find you need to appeal or reapply depending on your situation.

What If the Insurance Panel I Apply for is Full?

It’s important to keep trying, particularly if the company is a key provider for the community you serve. In addition to your license and resume, a short bio attached to your application can help make your case. The quick-start guide outlines this approach but most important is to create a succinct, compelling at-a-glance picture of your qualifications including:

  • Any unique and relevant qualities about you/ your practice.
  • Interesting/unique attributes of the population you serve.
  • Advanced or specific modalities you are trained to provide.

Finally, just know that the benefit to your practice and your client community is worth the extra effort. The idea here is to stay the course and remain focused. A clear plan and personal resilience will ensure you can effectively offer your services to a host of insured clients.

You can do this; we’re here to help. Check out this bundle I have for sale on this topic: Credentialing 101. Please reach out soon and we’ll tackle this important step together!If you don’t want to do the credentialing yourself, check out for a qualified credentialing specialist.

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