Starting a Medical Practice: Credentialing with Insurance Companies

CREDENTIALING according to wikipedia is defined as the administrative process for validating the qualifications of licensed professionals, organizational members or organizations.

This is the fun part. We will talk about how to enroll as physician provider for various insurance companies. This probably is a big deterrent for many physicians from starting a new practice. I will try to simplify the process, so it does not sound that intimidating. First thing to keep in mind is that the medical insurance companies need physicians to enroll as providers, aka get credentialed. More physician providers they have, the better they look. And trust me, they do care about their looks! More providers means they can enroll more members. And get more money. So they some representatives dedicated solely to enrol MDs as providers for their plans.

The simplest way to describe the whole credentialing process is as follows:

STEP 1: Call the designated representative of a medical insurance company and ask them to send you the credentialing forms.

STEP 2: Once you get the forms, spend hours filling them up.

STEP 3: Mail the forms back to them.

STEP 4: Call them to follow up. Make sure they have everything they need before the next credentialing committee meets.

STEP 5: Wait !! (Waiting can last as long as six months!!) 

I hope this makes you familiar with the credentialing process now. It is as simple as above, rest is all redtape. All you have to do is make a list of all the insurance companies, HMOs and PPOs etc. you would like to apply for. Then repeat the process for each of them. If you have already employed an office manager, he or she should be able to call these insurance companies, get forms, fill them and follow up for you while you focus on other issues. Sometimes other practices may let you hire their business manager part time to do this tedious work.

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TIP: To get the list of medical insurance companies you want to get credentialed with, call the billing department of the hospital in the area. Hospitals are usually credentialed with most, if not all the medical insurance companies. You can get a comprehensive list of medical insurance companies from them.