Frequently Asked Questions
General Questions About Insurance Credentialing
What is insurance Credentialing?
Insurance credentialing is the process of getting healthcare providers approved to join an insurance company’s network as an in-network provider, allowing them to see patients with that insurance and receive direct reimbursement.
Why is insurance credentialing important?
Being credentialed with insurance companies allows you to expand your patient base, receive direct insurance payments, and typically earn higher reimbursement rates compared to out-of-network providers.
How long does the insurance credentialing process take?
The process typically takes 60-120 days, depending on the insurance company. Some payers may take longer, while others might process applications more quickly.
What is provider enrollment?
Provider enrollment is the process of registering with insurance companies to become an in-network provider, establishing your ability to bill and receive payment for services rendered to their members.
Application Process
What documents do I need for insurance credentialing ?
Common requirements include:
- Professional license
- DEA registration (if applicable)
- Malpractice insurance
- Board certifications
- CAQH profile
- NPI number
- Practice information
- Educational history
- Work history
What is CAQH and why is it important?
CAQH (Council for Affordable Quality Healthcare) is a centralized database that stores provider information used by multiple insurance companies. Maintaining an updated CAQH profile is crucial for successful credentialing.
Can I see patients while my credentialing application is pending?
You can see patients, but you may not be eligible for in-network reimbursement until your credentialing is approved. Each insurance company has different policies regarding retroactive billing.
What happens if my credentialing application is denied?
We help you understand the reason for denial and assist with appealing the decision or addressing any issues to resubmit the application successfully.
Maintenance and Updates
How often do I need to update my insurance credentialing?
Most insurance companies require re-credentialing every 3-5 years. However, you must report any
significant changes (like location changes or license updates) as they occur.
What changes require updating my insurance credentialing?
You need to update your credentialing when:
- Changing practice locations
- Updating license or certifications
- Modifying tax ID numbers
- Adding or removing services
- Changing practice name or ownership
How do I maintain my CAQH profile?
CAQH profiles need to be attested every 120 days. We help monitor these deadlines and ensure your information stays current.
Working with Alpha Core Health Care
What credentialing services does Alpha Core Health Care provide?
We handle:
- Initial insurance credentialing applications
- CAQH profile management (Creating and Maintaining)
- Medicare/Medicaid enrollment
- Commercial insurance enrollment
- Application tracking and follow-up
- Renewal management
- Issue resolution
How do you help streamline the credentialing process?
We:
- Manage applications across multiple insurance companies
- Track application status
- Handle follow-up communications
- Ensure accurate documentation
- Monitor deadlines
- Resolve issues promptly
Do you handle Medicare and Medicaid enrollment?
Yes, we assist with both Medicare and Medicaid enrollment processes, including initial enrollment, revalidation, and updates.
What types of providers do you help with credentialing?
We assist all healthcare providers, including:
- Physicians (MD/DO)
- Nurse Practitioners
- Physician Assistants
- Mental Health Providers
- Physical Therapists
- Occupational Therapists
- Other healthcare specialists
Insurance Network Development
How do I choose which insurance companies to credential with?
We help you analyze:
- Local market demands
- Patient demographics
- Competitor networks
- Reimbursement rates
- Processing times
- Contract terms
Can I credential with multiple insurance companies simultaneously?
Yes, we can manage concurrent applications with multiple insurance companies to expedite your
network development.
What is the difference between in-network and out-of-network status?
In-network providers have contracted rates with insurance companies and typically receive direct payment. Out-of-network providers may have to bill patients directly and often receive lower reimbursement rates.
Compliance and Requirements
What are the consequences of seeing patients without proper insurance credentialing?
Seeing patients without proper credentialing may result in:
- Denied claims
- Delayed payments
- Need to bill patients directly
- Potential contract violations
- Lower reimbursement rates
How do you ensure compliance with different insurance requirements?
We:
- Track individual payer requirements
- Monitor deadline compliance
- Maintain required documentation
- Update information as needed
- Handle revalidation requirements
What if I need to add new insurance companies later?
We can help you expand your insurance network at any time by managing the credentialing process with new payers while maintaining your existing enrollments.
Services
Contact Us
- hello@alphacorehealthcare.com
- (302) 304-8686
- 3524 Silverside Rd, Wilmington, DE 19810, United States
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