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The Credentialing Process is So Slow!

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Are you tired of waiting on credentialing?

Here are some ways to avoid delays

Does it seem like the credentialing process is taking forever? Why is the process so slow? There are multiple factors that affect the credentialing process, but let's look at the significant factors that can delay the process.

1. During COVID, the insurance companies relaxed their requirements so that providers could quickly be credentialed to serve patients. Now that the COVID crisis is over, the insurance companies are not only returning to pre-COVID standards and requirements, but they have revamped the process to add more requirements.

  • Extra supporting documentation is needed.

  • New applications have come out for each insurance company requiring more information.

  • The insurance companies have had new software/portal upgrades in the last year with new ways to submit credentialing applications.

  • Applications have been lost to the void due to glitches in the software updates. This means the application has to be resubmitted and the waiting starts again.

2. Several insurance companies have lost employees due to strikes, layoffs, and lawsuits, which has resulted in the companies being short-staffed and overwhelmed.

  • It sits in a virtual pile until a rep picks up your application.

  • Once the application is assigned to a rep, it will go relatively quickly as long as there are no errors on the application, no missing documentation, or no extra info is needed.

3. Each state and each insurance company has its own standards and requirements. This means that even if BCBS in one state processes an application within a specific timeframe, BCBS in another state might take months.

  • Some processes are a 5-page application, and the provider's CAQH must be up-to-date. Other processes include a thirteen (yes 13) page application, 7-8 supporting documents, ensuring CAQH is current, and follow-up documents with providers' signatures.

  • Some insurance companies require the application is submitted through a specific portal. Other insurances want the application emailed or faxed. Yet others only accept the information over the phone.

Any information that is incorrect or not current causes a delay until the data is corrected. If the application is submitted to the wrong portal or insurance, it may take weeks for them to notify you. That application must be submitted to the correct site/insurance, and those weeks are lost. Even if everything is correct on an application, there's no guarantee that a credentialing application will be processed in a specific timeframe. However, ensuring the correct application is sent to the right insurance with the required documents will make the process smoother and quicker. This cuts down delays in correcting mistakes or redoing applications.

If you're experiencing delays and errors, look into the root of the problem to see the issue. Not sure where to start looking? Call us today for a free 30-minute consultation, and we can point you in the right direction.

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