General Category > General Questions
Credential question
ste:
I can relate about completing an application and thinking every possible question could have been asked and the insurance or network organization has been thoroughly researched and few weeks after submitting the application the physician gets a brief postcard in the mail saying "we don't credential naturopaths". One does quickly learn to ask the right questions.
Pay_My_Claims:
--- Quote from: KimGailey on May 11, 2010, 07:00:33 PM ---I found a great website to do credentialing at www.caqh.org
My question is, does a Dr have to complete credentialing with the insurance company to file a claim with them? If they don't do the credentialing, wouldn't it just be out of network?
--- End quote ---
physicians have to be invited into CaQh
Michele:
CAQH isn't really a website to 'do credentialing'. It is an online universal credentialing application that many insurance carriers utilize to reduce the paperwork required to credential a provider. Charlene is correct, CAQH is not something a provider can sign up for. CAQH numbers are only issued by insurance carriers. CAQH cannot (well they can but they won't) assign CAQH provider numbers to a provider. CAQH is a wonderful tool, but it doesn't replace credentialing, it just assists. Each insurance carrier must still be contacted and most still have additional paperwork that must be completed in addition to the CAQH.
Michele
DMK:
I'm a little concerned about some of the questions being asked. It seems like there are some billers out there who are in WAY over their heads. It makes me wonder if offices are hiring completely inexperienced employees and making them "figure it out". Hmmmmm.
PMRNC:
::)
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