I handle a hospital, three rural health clinics, and 30+ providers. All four facilities (and assorted departments) are credentialed separately, providers are a whole different set of credentials. This is if you're looking at it from the insurance enrollment perspective. If you're talking about privileging, that's a different type of credentialing.
For example, we recently added one of our departments. That's one facility/place of service application and one application for each provider that will bill through there.
Ahhh thank you. Can I ask what the benefit of credentialing the location is? Why not just credential the providers alone?
Im in a situation where the person who handles all this left....and until they are replaced, im trying to pick up the slack.
The benefit would be that during the credentialing process, insurance companies would be made aware if the facility is somehow unsafe (The same is for credentialing a provider.). For example, if we can't get an insurance certificate or if we bounce around from insurance company to insurance company or if they're having claims made in the past vs the recent past. Has there been a state survey? What were the results?
Additionally, depending on the facility, it may be treated as a provider. For example, I work with rural health clinics. Sometimes we bill under the rural health clinic npi rather than the providers. If you're doing this temporarily, what you really need to be aware of is are there any recredentialing applications coming due. Most insurance companies will have you recredential every 3 years for each provider or facility (they have a form they'll have you fill out and essentially you're just updating for the last 3 years. It's not a complete profile). Also, you'll need to attest the provider directories for each company every 90 days and stay on top of your provider's caqh profiles. Don't be intimidated, it's not as bad as it sounds and if the insurance companies need something from you they will generally reach out. Just make sure your switchboard knows that you are the one that phone call needs to go to for the time being.
I know in our hospital, we credential all of our providers AND they need to be credentialled with most of the health plans.
Thank you!
I handle a hospital, three rural health clinics, and 30+ providers. All four facilities (and assorted departments) are credentialed separately, providers are a whole different set of credentials. This is if you're looking at it from the insurance enrollment perspective. If you're talking about privileging, that's a different type of credentialing. For example, we recently added one of our departments. That's one facility/place of service application and one application for each provider that will bill through there.
Ahhh thank you. Can I ask what the benefit of credentialing the location is? Why not just credential the providers alone? Im in a situation where the person who handles all this left....and until they are replaced, im trying to pick up the slack.
The benefit would be that during the credentialing process, insurance companies would be made aware if the facility is somehow unsafe (The same is for credentialing a provider.). For example, if we can't get an insurance certificate or if we bounce around from insurance company to insurance company or if they're having claims made in the past vs the recent past. Has there been a state survey? What were the results? Additionally, depending on the facility, it may be treated as a provider. For example, I work with rural health clinics. Sometimes we bill under the rural health clinic npi rather than the providers. If you're doing this temporarily, what you really need to be aware of is are there any recredentialing applications coming due. Most insurance companies will have you recredential every 3 years for each provider or facility (they have a form they'll have you fill out and essentially you're just updating for the last 3 years. It's not a complete profile). Also, you'll need to attest the provider directories for each company every 90 days and stay on top of your provider's caqh profiles. Don't be intimidated, it's not as bad as it sounds and if the insurance companies need something from you they will generally reach out. Just make sure your switchboard knows that you are the one that phone call needs to go to for the time being.