Medical provider recredentialing
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What is recredentialing?

 What is recredentialing?

Medical recredentialing is process, where all professional healthcare providers in United States are required to update and confirm their existing information with insurance networks after certain time period.

It is also called revalidation or re verification and it takes place after initial credentialing process.

Recredentialing allows the medical practitioners to update the demographic updates such as practice locations, contact information or other related information.

Sole purpose of this exercise is to ensure that all the In-Network healthcare providers keeps their information accurate and any changes to their profile has been properly communicated to insurance network..

Insurance panels share your updated information in their provider directories which they make available for patients.

As compared to physician credentialing its simple but important process, it may take as minimum as 5 working days in order to update all the required information for recredentialing however the credentialing for first time may take up to 120 business days.

I assume that you are well aware of the importance of credentialing, if you are not, believe me it’s the back bone of your medical practice cash flows.

Therefore, you must keep track of when you’re credentialing or provider enrollment term is going to expire with Medicare, Medicaid, Tricare, Aetna, and Cigna, or similar payers.

 How often, recredentialing is needed?

Hospitals and facilities are required to recredential every three years whereas physician and non-physician professionals are required to revalidate their information every 120 days.

 What happens if you don’t get it on time?

It can cost you time, money and hassle.

You can be kicked out from insurance panel if you keep treating patients even after expiry of your agreement with particular insurance panel.

You can also lose reimbursements in case your claims are rejected by the insurance panel if you don’t revalidate your information on time.

 What you need to do?

In order to keep things organized you would have to keep an eagle’s eye on following.

  Re-attest CAQH profile every 3 months

Physicians working with 3rd party insurance panels need to attest or revalidate their information every 120 days.

If you fail to update your CAQH profile on schedule your billed claims may get rejected.

  Update CAQH profile on each demographic update

If there is change in any of provider’s demographics, that needs to be updated in CAQH profile, As CAQH contains a wide variety of information, it’s hard to maintain if you don’t review and update this information on regular basis.

  Re-Negotiating the Contract

The contract term between physicians or healthcare provider and third party insurance panel is normally for the term of two years.

On the end of term period you need to re-contract in order to secure your credentialing or enrollment with the insurance panel.

The re-contracting also provides an opportunity to negotiate service rates or other clauses.

 How to complete the re-credentialing process?

Once you receive notification for re-credentialing, the sole purpose of that notification is to ensure that your professional qualifications remain valid and current.

The notification will guide you towards to next necessary action according to your specialty.

  For Medical Providers

If you have an updated profile on CAQH Pro-ViewTM , you may not need to take any action while re-credentialing.

In case you want to update some information then login to CAQH ProView and update your information.

Once you have entered your updates, you need to confirm that all the information is correct and current.

  For Medical Facilities & Hospitals

You will have to fill the recredentialing application form and send the same to insurance panel.

Read the guidelines carefully in the notification received from the specific insurance network. You can also visit their website to find the specific form. Just fill the form

It can take up to 5 business days to complete your recredentialing process once you submit all the requested supporting documents and the same have been received by insurance payer.

  How to check status of re-credentialing application?

You can check the status of your credentialing application by sending an email request to relevant insurance panel at their given email address.

The email address can be found from website of the insurance panel.

 Final advice.

While writing them an email in order to check your re-credentialing application status, please do include the healthcare provider’s full name, tax ID and National Provider Identifier (NPI)

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