Provider credentialing is often referred to as Primary Source Verification. The process is used by hospitals, health plans, and other facilities to verify the credentials of a particular physician or provider (also see What documents are required for provider credentialing? under FAQs list). You may also hear provider credentialing referenced interchangeably as insurance enrollment. Although we do not provide primary source verification services (i.e., verification of credentials), we do enroll providers with insurance plans across the country. Whether it’s enrollment in Medicare, Medicaid, various commercial insurance plans, or even the various worker compensation networks, our team of credentialing specialists have decades of experience to ensure the expert care and attention your practice deserves.

Well, to be honest, it depends—there’s not a single answer. For example, the length of time it takes to credential is:

• Usually shorter if a physician or provider is already enrolled in a health plan (i.e., insurance coverage). But it takes longer for a provider who has never completed credentialing with an insurance company.
• Usually shorter if the provider is already affiliated with a practice group’s tax ID. But it takes longer for a new provider who must first be contracted with a practice group’s tax ID before linking the provider to the group’s health plan.
• Usually shorter if your existing practice group already has a provider contract in place. In this case we don’t need to complete the provider’s initial contracting process with the practice group. But it takes some time to credential new providers and link them to your established group.

With all of this being said, the time frames vary between 60 to 180 days depending on your unique scenario. This is why our CEO likes to have phone discussions with all potential clients to set realistic expectations regarding the anticipated time frame.

CAQH stands for Council for Affordable Quality Healthcare. It’s essentially an online database account that stores provider information. Providers typically grant access to their information to insurance companies.

An overview of CAQH includes the following benefits:

• Of all the national health insurance companies, 90% use CAQH as a prerequisite for their enrollment process.
• The CAQH centralized database with required authorization is considered an industry-wide standard that supports a more efficient credentialing process.
• Instead of calling your office for the provider’s work history or copy of a medical license, insurance companies can pull it directly from your CAQH file.

CAQH Credentialing process:

• Obtain your CAQH ID (within 2-3 business days)
• Set up your secure username and password
• Complete the online application and send in required documentation
• Send your attestation for signature which certifies the application
• Grant insurance companies access to your online application
• You are now ready to start the credentialing/contracting process with the insurers