Get on Insurance Panels FAQ – What you need to know about credentialing
What is the credentialing process, when working with you?
Essentially, we manage all of the tedious, time-consuming work you don’t have time for.
We start by sending you a simple application we call the Master Survey. It asks you basic questions about what your education, expertise and license. This allows us to get to know you and so that we can identify the best way to get you on the panels you want.
Once this is done, we work with you to determine which insurance companies are a great match for your practice. We’ll provide a list of our best recommendations after researching the area you operate out of.
At that point, we handle the strenuous process of retrieving the credentialing applications, filling them out, submitting them and then following up continually to ensure that the insurance company approves the applications timely and efficiently.
We update you throughout this process via phone and an online dashboard that displays the status of your applications. We let you know immediately whenever we need additional information for your application, such as signatures.
Have more questions, check out our most frequently asked questions below.
FAQ:
Q: Why would someone want credentialing? A: Being credentialed with insurance panels means that you are able to see patients who have specific insurance plans and bill those insurance companies for the services you render. This can greatly increase the number of patients who can access your services.
Q: What is the process of getting credentialed with insurance companies?
Q: Do I get to choose the panels I want to be on?
A: Yes. When you sign up for credentialing with us, you get to choose exactly which panels you want, and don’t want, to be credentialed with.
Q: What if I don’t know which panels in my area are best for me?
A: We can help! One of our credentialing specialists will talk with you by phone and can help you to select the panels in your area that will be best fit for you and your practice.
Q: What are some of the more popular insurance companies?
A: The popularity of insurance companies varies depending on location. However, some of the most popular and largest insurance companies are Blue Cross, Blue Shield, Aetna, Cigna, Magellan, Tricare, United Healthcare, Humana, Coventry, Highmark, Health Net of California, Kaiser, Wellpoint, Wellcare, Regence Group, Value Options, Medicare, and many others.
Q: How long does the credentialing process take?
A: The credentialing process generally takes between 90-120 days. When you sign up for credentialing with us, we waste no time getting your applications completed and submitted to insurance companies. We then follow up regularly with insurance companies to make sure that your credentialing applications are processed and approved as soon as possible.
Q: How many hours of work does insurance credentialing take?
Q: Do you have experienced credentialing providers in my area?
A: You bet! We have credentialed literally thousands of providers across the United States, including providers as far off as Alaska and Hawaii. No matter where your practice is, we have the experience needed to get you credentialed.
Q: Do you have experienced credentialing providers in my specialty?
A: We have credentialed healthcare providers of more types than we can list: from chiropractors, to behavioral health providers, to surgeons. If you are eligible to be credentialed, we can get you credentialed!
Q: Am I guaranteed to get on the panels I choose?
A: If you are fully licensed, we should have no problem identifying plenty of insurance companies and third party payers for you to be credentialed with. In some areas, some panels can be very selective or closed. In these instances, we will talk with you about the likelihood of a successful credentialing process. We want you to get the most out of your credentialing investment!
Q: What if the insurance panel I want to be credentialed with is closed?
A: Finding a closed panel can be frustrating. However, sometimes when panels say they are closed, they are still accepting providers, but on a limited basis. In the case of a panel saying that they are closed, we can still submit an appeal to the insurance company on your behalf. During an appeal, we will try to connect with the insurance company representative assigned to your area. We will then stress important parts of your qualifications and clinical practice. For instance, perhaps you have a specialty that the insurance company desires, or you are practicing in a neighborhood that is underserved. We do have success with many of our appeals. However, if a company is saying that their panel is closed, it might not be possible to get on the panel at that time.
Q: What if all the insurance panels are closed?
Q: Can interns / limited-license providers be credentialed with insurance companies?
A: Sometimes, but it’s highly unlikely. We have had success credentialing such providers on a limited basis—generally in areas that are very underserved. In most cases, insurance companies are looking to network exclusively with fully licensed healthcare providers.
Q: Can an intern bill patients under a supervising provider?
Q: How long do I need to wait after getting licensed before I can get on insurance panels?
Q: What exactly is a panel?
A: Good question! When we use the term “panel,” we are using an abbreviation for insurance panel, which is the group of doctors who are networked with the insurance company and are able to provide services for patients that have that insurance. A panel could also be an EAP Panel, which is the same thing, but with an EAP (Employee Assistance Program).
Q: What is an NPI number (an NPI 1, and an NPI 2)?
Q: What is CAQH?
Q: Can I get credentialed with an EAP (Employee Assistance Program)?
A: Yes! Like insurance companies, EAPs are valuable third party payers to be credentialed with. The credentialing process is very similar to being credentialed with insurance companies. In fact, some of the major insurance companies also offer an EAP. Popular EAPs include: ComPsych, OptumHealth, Magellan, Horizon Health, Mines and Associates, ValueOptions, Cigna, and Harris-Rothenburg International.
Q: How much does credentialing cost?
Q: How can I track my insurance credentialing progress?
Q: Can an LMHC accept Medicare?
Q: What is the process for getting credentialed with Tri-care?
Q: Can providers with a disciplinary action on their record still be paneled?
Q: DIY Credentialing: the number one challenge:
Q: DIY Credentialing: the challenge of “missing” information:
Q: For Physicians: do I need to be “Board Certified” to get on insurance panels?
Q: Do you provide medical billing?
A: Thriveworks offers billing services to it franchisees. Learn more about the exciting benefits of opening a Thriveworks Counseling center in your area, here: Counseling Franchise.
I am trying to get through the CAQH credentialing form. I have completed the information,fixed required issues, done the audit and the review but when I press ‘attest’ I get a ‘go back ERROR’ message. I have tried many times, removed pop up blocks, re installed ADOBE. Nothing works. How can I get past this problem?
I have been in private practice in Michigan from last 14 years. I am planning to open a second practice in California. I don’t have a medical office address yet in California. However, I already have CA state medical licensure. I would like to use my California home address for credentialing applications. Do you deal with medical credentialing in California state ?
I am in private practice in Deerfield Beach Florida. I am also on most insurance panels and understand the process of how difficult it can be. My question is that I have grown to be able to hire two contract workers and constantly market my office. I am so grateful that I have been able to do this but I am now stopped by the insurance companies who say that the contract workers need to be on the panels individually and most of the big ones are closed. My contract wrkers have different specialties than me, one works with substance abuse and trauma and one works wth children and adolescense. I have written to the insurance companies several times describing the differences of the therapists, the availability as we are open 6 days a week. Our emergency services which has a therapist on-call, as well as stating how important it can be for continuity of care if a family can be seen in one place andthe convenience for the family. I hve also hired a psychologist and have added that to my request and continue to get denied. At this point, I am ready to grow, but I am stuck! Any help would be beneficial. Thanks Lori
What is your cost for your services?
I am credentialed with several insurance companies through the agency with which I contract. I am thinking about moving out from that agency. Will I need to start over with all credentialing under my own PLLC business name or will I be able to just coordinate with the insurance companies to move it to my own business?
Hi Faith,
Thank you for your question. If you are credentialed individually under your agency then you are only required to do a demographic update. A demographic update is a form that is filled out to change your information. This “update” can take up to 45 business days. However, if you are credentialed under the group through your agency then you have to start over. This requires for you to be dis-enrolled at your current location then filling out a new application. Basically if you are credentialed individually you can take your credentials with you when you leave and if you are credentialed under the group you cannot take them with you. I hope this answers your question. Please let me know if you have any further questions or would like to move forward with either process.
Thank you,
Chelse’ Matheny
I am moving from CO where I had a cash practice (and per State Laws did NOT need to be licensed) to NY – so I am unlicensed. I will register for a limited permit for NYS but am wondering if I am under supervision in private practice, can my Supervisor bill insurance companies for my work while I am pre-licensed/unlicensed? Or, in NY can I only be supervised and gain hours for licensure and be paid by a Medicaid funded facility. Thanks in advance!
In general (95% of cases) you cannot accept insurance, even under the supervision of a licensed and credentialed supervisor. Sorry!
I am setting up a new private practice in a new part of my state. I do not have an office yet and I want to start the credentialing process through CAQH. Is it any more of a hassle to use my home address while I look for office space? I just don’t understand how I am to afford an office while waiting to be credentialed.
Thank you.
Hi Laura,
What you are experiencing is actually pretty common. Credentialing is a lengthy and complicated process and the address issue is just one of many catch 22s. If you use your home address, you will need to eventually change it to your work address. The credentialing process takes 90-120 days, and the address change process can take up to about 30 days. Laura, if you think we could be of help, give us a call anytime at 1-855-4-THRIVE.
Can an LCPC in Illinois bill for Medicare and/or Medicaid?
Laura, LCPCs can bill for Medicaid, but not Medicare.
Regards,
Anthony
I just passed my LCPC exam. I know it will take some time for my license to actually post but I was wondering if there is anything I can be doing now to get the process if medical credentialing started?
Absolutely! You can begin reaching out to the insurance companies that you want to work with, and requesting their giant applications. You can begin filling them out, putting your resume into the crazy format they request, and get everything ready with the exception of your license #. Once your license # comes in, fill in that final blank, and get those applications in to the insurance companies! –We have a lot of providers contact us after they’ve taken their exams, and we get started with their credentialing even before their license # comes in. –I hope this helps! 🙂
I am moving to another city and going to be opening my own practice. I know it takes about 90 days. Do I have to wait to move to apply or can I go ahead and get started on the process?
The question depends on a few factors, including licensure and practice address. Would you like to call us at 1-855-4-THRIVE? We could help you to review your options!