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Frequently Asked Questions

General Questions About 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.

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.

The process typically takes 60-120 days, depending on the insurance company. Some payers may take longer, while others might process applications more quickly.

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

Common requirements include:

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.

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.

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

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.

You need to update your credentialing when:

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

We handle:

We:

Yes, we assist with both Medicare and Medicaid enrollment processes, including initial enrollment, revalidation, and updates.

We assist all healthcare providers, including:

Insurance Network Development

We help you analyze:

Yes, we can manage concurrent applications with multiple insurance companies to expedite your
network development.

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

Seeing patients without proper credentialing may result in:

We:

We can help you expand your insurance network at any time by managing the credentialing process with new payers while maintaining your existing enrollments.

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