The Big Four: Tips for Timing Urgent Care Credentialing

Many providers and entrepreneurs who dive into the startup process may not understand the importance of timing urgent care credentialing steps. Along with contracting with payors, credentialing providers is one of the first processes you need to undertake in tandem with development of the center.

Here we offer four tips – and they’re biggies – to keep in mind during what can be a very lengthy process.

• Timeframes: Always plan for a six-month process to take place on the payor end. The accrediting body that each health plan follows allows a certain period of time for application processing. Most health plans follow NCQA (National Committee for Quality Assurance), and they allow 180 days or six months for applications to be fully processed. Plan on this timeframe. If the process doesn’t take this long, fabulous!

• Collection of credentials: Collect all of your provider’s credentials before they start working in your clinic, preferably six months in advance. Your credentialing person will need credentials from new hires in order to complete the payor applications and submit them to the health plans for processing and approval. Collecting partial credentials is not sufficient. If an incomplete provider credentialing application was submitted to a health plan it would likely be declined and either returned to the provider or set in the trash. Health Plans are moving in the direction of having zero tolerance for incomplete applications.

• Delays: Always plan on unexpected delays during application processing. Below are some examples:
  • Providers may have adverse actions that require additional review
  • Licenses may expire while the application is processing, requiring the payor to collect the updated documents.
  • Payors may have an influx of applications to process and may be behind
  • A payor may be unable to verify a provider’s training

• Pushing: Many of us have the desire to push the health plans to move things along and quickly. Don’t.  There are tactful ways to follow up and inquire about how the process is coming along. Health plans do have the right to not allow facilities and providers into their network.  In most cases pushing and acting forcefully only pushes the health plan reps away from collaborating with providers and facilities.  If the health plans do act on pushing from a provider or office manager, they will likely remember that experience and hesitate or refuse to work with them again.

The experienced Practice Velocity credentialing team can help you at any step in the process. Learn more by calling 888-357-4209.