Credentialing process timelines

While the credentialing process is not rocket science, it does require meticulous efforts to reduce errors and rejections. Plan for a good 90-120 days, start to finish.

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Plan for a good 90-120 days, start to finish.

If there are any errors or mistakes in your submission, then the timeline starts over again.

While the credentialing process is not rocket science, it does require meticulous efforts to reduce errors and rejections.

First, you are going to get credentialed (i.e. the payer will verify the credentials you submitted). That is, if your documentation was error free.

Then, you are going to get a contract.

This contract is also going to have effective dates.

This is when you actually are “par” (aka participating provider).

Keep in mind that unless you are “par”, you cannot bill the payer.

Most, if not all, payers do not allow retroactive billing.

Medicare is a tiny bit faster – 60 – 90 days.

However, this will vary based on the state (i.e intermediary).

However, the good thing about Medicare is that they will consider the application receipt date as the effective date.

This allows you to retroactively bill Medicare.

Additionally, you also get a 30 day grace period from Medicare that’s above and beyond the effective date.

So, you get to bill retroactively for 1 more month.

DMEPOS applications are harder to get approvals for.

For DMEPOS suppliers, you need to plan for some additional time for sure.

Medicare scrutinizes DMEPOS applications a lot – primarily due to all the scams that had come to light of late.

Expect a site visit 🙂

Plan for a total turnaround time of 90 – 120 days. There’s nothing you can do to speed this up.

Or, can you?

Here’s one thing you can do.

When you hire a new provider, make sure you hire one that’s already credentialed with various payers.

Next, have these payers add your business location/tax ID to the provider’s records. This will get your process sped to completion in about 30 days.

Go ahead, try it out !