How does a healthcare professional become contracted with insurance companies? – In order to start seeing patients/members, you will need to become credentialed and contracted with each insurance network. Yes, this is two step process. Once you have completed both, you will reflect as an in-network healthcare professional, ready to offer services! And you will be properly reimbursed for your services, too!
Through the years of having direct hands on experience, we are proficiently equipped to help you reflect as an in-network.
In order to start seeing patients/members, you will need to become credentialed and contracted with each insurance network. Yes, this is two-step process for each network (except for Medicare, Medicaid and a handful of commercial payers). To completing both credentialing and contracting, a realistic time frame is around 2-9 months from start to finish. The timeframe is always subject to change depending on the network’s requirements. Through years of direct hands on experience, we are proficiently equipped to help you reflect as an in-network healthcare professional. To give a better idea of what to expect, please read through the information provided below.
When the process is completed & you can see patients as an in-network provider, what happens now?
Please see our re-credentialing and maintenance page for more information!
What is credentialing?
Credentialing is the verification process to establish qualifications of licensed medical professionals. During the credentialing process, all healthcare professionals must provide documentation of completed education, past and present licensure, previous work history, past and current hospital privileges, certifications, and much more. Typically, the credentialing process can take anywhere from 30-120 business days from start to finish.
What is contracting?
Once you have completed the credentialing process and the network has verified that you are eligible to provide care to their patients, you will be extended a network contract. The contracting phase is the most important part of the process to become in-network. The network contract will list out all the details of what plans and products are you participating with, plus your reimbursement rate for the services that you plan to provide. It can take anywhere from 30-90 business days for the network to process, countersign and load your contract into the systems. Please note that the 30-90 business day for the contracting portion is in addition to the credentialing time frame. After you have completed both credentialing and contracting, you will reflect as an in-network healthcare professional, ready to provide services!