Credentialing and New Practice Question

[StephD]

What is the typical time frame for the insurance carriers to process credentialing paperwork to get a provider in network?  This would be for a new group practice involving ST's, PT's and OT's.  They are trying to get an estimate of how long it would be before they would start having insurance reimbursements coming in.  I know they could start out as out of network until they get credentialed, but in an ideal situation wouldn't you want to be in network before seeing patients so that the initial cash flow would be a little better?
The major carriers in our area are Blue Cross Blue Shield, United Healthcare, Aetna, and CIGNA.
THANKS!

[Michele]

Hi,
   Average credentialing takes anywhere from 2 to 6 months.  It really varies from carrier to carrier.  I personally feel that if you plan on participating it is better if you start out that way.  Most carriers start your participation date from the date you submit your application, or the date you indicate on the application that you will be opening.  For example, if you submit your app with Cigna and indicate you will be opening Sept 1st, they may  not finish the credentialing until Sept 15th, but they put your effective date down as the first. 

BCBS goes by the date you sign their contract.  You have to start the credentialing process, then they send you contracts.  Your participation effective date is the date you signed (at least NY BCBS).

You are also going to need to do CAQH apps (if you haven't already) for each therapist and those each take time.  Many of the carriers you mentioned require the CAQH apps.

If you know when you are opening (approx), the address, and the therapists then you may want to start contacting the carriers now to get some of the paperwork moving.

Good luck
Michele

[StephD]

Thanks Michelle!  You guys are such a wealth of knowledge and information!
Stephanie

[cohenmk]

Also if you see Medicare patients, they will retro back to the date you first saw patients.  Medicaid, in our State, allows 6 months from the date you saw your first patient, to submit a "Completed" application.  Also WC, in our state, allows to see patients right away.....

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