A Complete Guide to Provider Credentialing and CAQH Management
A complete guide to provider credentialing and CAQH management, covering the process, common delays, and how to speed up enrollment.
Provider credentialing is one of the least visible parts of running a practice, right up until it causes a real problem. A new provider who cannot yet bill payers, or an existing provider whose re credentialing lapsed without anyone noticing, can quietly cost a practice thousands of dollars in delayed or denied revenue.
What Is CAQH and Why It Matters
CAQH (Council for Affordable Quality Healthcare) maintains CAQH ProView, a central database used by payers during enrollment. Keeping this profile accurate and regularly attested prevents unnecessary enrollment delays.
The Credentialing Process Step by Step
- Collecting provider licenses, DEA registration, and work history
- Creating or updating the provider's CAQH profile
- Submitting enrollment applications to each payer
- Proactive application tracking and follow-up
- Confirming final approval and effective billing dates
Frequently Asked Questions
Q: How long does provider credentialing take on average?
A: Credentialing commonly takes several weeks to a few months. Proactive follow up and a complete CAQH profile are key.
Q: When should a practice start credentialing for a new provider?
A: Ideally 90 days before the provider's expected start date.
About MediSync RCM Team
MediSync RCM's credentialing team handles CAQH attestations and payer enrollment for practices nationwide.
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