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:

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:

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:

How do you ensure compliance with different insurance requirements?

We:

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.