How Long Does It Take To Get Credentialed With Insurance?

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As a healthcare provider, getting credentialed with insurance is a necessary step to ensure that you can receive payment for your services. However, the process of credentialing can be a lengthy and confusing one, leaving many providers wondering how long it will take to become fully credentialed. In this article, we will explore the ins and outs of the credentialing process, as well as provide insights on how long it typically takes to become credentialed with insurance.

What is Credentialing?

Credentialing is the process of verifying a healthcare provider's qualifications, education, training, and experience to ensure that they meet the standards required by insurance companies. The process involves the completion of an application, which includes providing documentation of credentials such as medical licenses, board certifications, and malpractice insurance. Once the application is submitted, the insurance company will review it to ensure that the provider meets their requirements.

Step 1: Application Submission

The first step in the credentialing process is submitting your application to the insurance company. This can be done online or through a paper application, depending on the company's preference. Once the application is submitted, it can take anywhere from 30 to 60 days for the insurance company to review it and determine if any additional documentation is needed.

Step 2: Primary Source Verification

After the initial review, the insurance company will begin the process of primary source verification. This involves contacting the provider's educational institutions, licensing boards, and other organizations to confirm the accuracy of the information provided in the application. This process can take up to 120 days, depending on the responsiveness of the organizations being contacted.

Step 3: Committee Review

Once the primary source verification is complete, the credentialing committee will review the application and make a decision on whether or not to credential the provider. This process can take up to 90 days, depending on the size of the committee and the number of applications being reviewed. If the provider is approved, they will be notified and added to the insurance company's network of providers. In conclusion, the credentialing process can take anywhere from 4 to 9 months, depending on the insurance company and the responsiveness of the organizations being contacted. It is important for healthcare providers to understand the timeline of the credentialing process and to plan accordingly to avoid any gaps in payment for their services. By staying informed and proactive, providers can ensure that they are fully credentialed and ready to provide quality care to their patients.

Step	Timeline
Application Submission	30-60 days
Primary Source Verification	Up to 120 days
Committee Review	Up to 90 days

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