Deirdre Roper

CREDENTIALING PHASE

 

I will submit a participating request to your chosen health plans using their specified credentialing application process, to include uploading of Licenses, Certificates, Diploma, CV, W-9's, Malpractice, Incorporation docs, EIN IRS Letter, and all other pertinent information. Once the health insurance company receives your credentialing application, they will perform a thorough verification process. Your file will then go to the company's credentialing committee for approval. This process can take upwards of 90 days.

 

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CONTRACTING PHASE

 

The second phase of the credentialing process is called contracting. This is when your practice or organization’s application has been approved, and you’re extended a contract for participation. Many insurance networks separate the contracting phase from the credentialing step.

 

I am with you through the entire Credentialing and Contracting phase from start to finish. A thorough review will be done before you (Authorized official) or I (Authorized representative) sign your provider agreement, including:

 

• Reviewing the language of your participating provider contract.

• Reviewing the responsibilities of participation.

• Reviewing the reimbursement rates.

 

Once your provider agreement has been signed, it will then go to the payor for countersignature. Payor countersignature could take up to 60 days. When the payor has finalized their process you will receive an effective date and provider identification number (PIN) in your payor "Welcome Letter". Then, you can start billing the plan and receiving your in-network reimbursements.