Author Topic: Credentialing & Applications  (Read 1192 times)


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Credentialing & Applications
« on: November 22, 2015, 08:12:32 AM »
I am new to the forum and I hope you could help me with a situation.
My ex-employer, a medical billing and coding company, has asked if I would be willing to do the provider's applications, Medicaid, Medicare, and other insurances. I will be following up until completion. Also will need to get some providers credentialed and in network with the insurance companies in the area. I will also have to keep CAQH up to date. I will be doing this remotely from home.
I am to decide how much I would charge per application. I will greatly appreciate any information on pricing and also what measures should I take legally when doing this from home considering it is outsource work, I will be doing this as a 1099 contract.
« Last Edit: November 22, 2015, 08:45:12 AM by abney »


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Re: Credentialing & Applications
« Reply #1 on: November 25, 2015, 08:30:03 AM »
First you need to check your local and state laws to make sure it is ok to work out of your home.  I have seen people get into serious trouble by working out of their homes when it is not allowed.

As far as charging, the fees vary greatly.  Without experience I would make it clear you are only doing basic credentialing, not contract negotiation.  For Medicare the fees by many companies vary greatly.  When I was doing Medicare apps  I charged from $175 - $325 depending on what apps they needed.  Solo provider enrolling individually on the lower end, group with multiple docs on the higher end.  Commercial carriers really vary.  Some have a very simple process while others have apps of MANY pages!  CAQH we used to charge $150 to complete.

Hope that helps.
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