Contracting is the process of becoming a payer’s participating (in-network) provider or group. The result is a fully executed contract with an effective date to treat patients and submit claims for reimbursement. Contact me for a contracting checklist for your new practice!

Credentialing is a formal process for verifying and approving the credentials of a provider. It confirms the health care provider’s education, training, work experience, license, etc. and involves direct communication from the educational/training institutions, licensing agencies, past and present hospital affiliations and employers, certification boards, and other sources. Contact me for a checklist of the documents and information needed to get started!

Because it's a lengthy process, most payers allow and encourage applications to be submitted sixty days before the provider's start date.

Most payers take two to four months, once all required information and documentation has been submitted.

It is a 10-digit number is a special identification number for healthcare providers. Issued by the Centers for Medicare and Medicaid Services (CMS), NPIs numbers can be issued to individual providers (Type 1), as well as groups/organizations (Type 2). To get a number, visit the National Plan and Provider Enumeration System (NPPES) website.

New and renewal applicants can get information, register, and submit applications by visiting the U.S. Department of Justice website.

Recredentialing is a review of a provider’s qualifications and history is that is performed routinely after initial credentialing. 

Most payers require recredentialing or revalidation be completed at least every three to five years. 

No. You must wait for your approval and effective dates. Seeing patients before receiving an official approval can result in claim denials or in providers being paid as if out-of-network.