Credential first - Knowing your fee schedule comes last

Why This Topic Matters

Credentialing can affect whether a practice can join a network, how long enrollment takes, and when a provider can begin billing. Understanding the general process helps practices prepare documents, track applications, and evaluate contracts once payer-specific information is available.

Article Sections

1. Getting Started-Commercial Plans

   Introduces the commercial credentialing workflow and the role of a national credentialing database used by many carriers. Covers registration, record access, attestation, and keeping supporting documents organized.

2. Important tip-

   Explains an additional step involved when updating database information and the need to confirm that changes are communicated properly. Emphasizes maintaining current records for carriers that access the system.

3. The next step is a piece of cake

   Describes the carrier contact phase after database registration and before contracting is finalized. Notes that carriers may request additional forms before moving forward.

4. Why does it take so long?

   Discusses general reasons credentialing timelines may vary, including specialty, location, and carrier demand. Also addresses the review process that can delay acceptance decisions.

5. Now the ball is in your court -

   Covers the general contract review stage after acceptance and the types of issues a provider may review before deciding whether to proceed. Focuses on broad contract considerations rather than specific coding details.

6. Don't forget the fee schedule

   Explains that fee schedule review comes after the contract is available and may require requesting payer-specific information. Highlights the importance of having relevant reimbursement information before making a decision.

7. Be informed

   Summarizes the need to compare available information before choosing whether to participate with a payer. Frames the decision as part of practice planning and financial evaluation.

8. Medicare Contracting/Credentialing

   Introduces the Medicare enrollment process and contrasts government plan requirements with commercial plan procedures. Mentions related coverage considerations and Medicare-specific forms and communication channels.

9. Important Tip-

   Provides a general reminder about related Medicare program participation and how claims handling can be affected. Focuses on enrollment coordination rather than detailed policy analysis.

10. Important tip

    Describes Medicare application processing and follow-up expectations, including the need to stay in contact and monitor application status. Also notes when providers may begin seeing patients versus submitting claims.