Credentialing Myths

Credentialing Myths 2017-06-30T09:47:38-06:00

The NPS credentialing team understands the importance of on-time credentialing and have the knowledge and systems in place to help your practice. We handle the mounds of credentialing applications and forms your practice receives, giving you more time to focus on patient care. Contact our team today to learn how we can help your practice with credentialing.

Tanisha Brewer-Lott, Credentialing Supervisor at Nephrology Practice Solutions

Contact Tanisha Today!




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Nephrology Practice Solutions team member Tanisha can help your practice with credentialing and licensing

I am credentialed for life

Credentialing is a requirement for most payer participation so that you may be considered an “in network” physician for patients. Credentialing is also required in order to obtain privileges to care for patients in a facility setting (such as in a hospital). In order to maintain approved status, your credentials are monitored by those entities you are credentialed with on an ongoing basis and you will be required to recredential with them on the intervals they define (normally every 2 to 3 years). You should always refer to the payer’s rules to ensure you maintain your approved status.

I can change practices with ease and not have to worry about credentialing (once credentialed, always credentialed – right?)

Changing practices typically requires you to notify all entities you are credentialed with at a minimum. Depending on the entity there may be additional requirements, such as completing credentialing related paperwork to participate under your new practice name and/or Tax ID Number.

I can complete one application for all of my credentialing needs.

There are efforts to streamline some payer credentialing (with CAQH) and there are some states that have a state-mandated credentialing application. However, many entities largely have their own applications or additional forms that must be completed as part of their credentialing requirements. Checking with the entities you need to be credentialed with is the best way to determine what paperwork needs to be completed.

I provided the requested application and documents to the requesting entity. My credentialing should be approved now, right?

Credentialing is a multi-step process, typically including several steps to verify your credentials and normally requires additional levels of approval before your credentialing is finalized. In our experience credentialing can take up to 4 to 6 months to finalize with some entities.

I have been a practicing physician FOREVER so I don’t really need to complete credentialing

The simple answer – No, sorry, you do. Unless your specific provider & specialty type is excluded from credentialing as determined by the health plan or facility (these are very limited exceptions in our experience), you will be required to comply with payer credentialing and recredentialing requirements.