What is Provider Enrollment?

Provider Enrollment refers to the process of requesting participation in a health insurance network as a Participating Provider. The process involves requesting enrollment, completing plans application, submitting required documents. Many commercial plans utilize CAQH to obtain credentialing information. The Provider Enrollment process varies by payor. Some plans take as long as 180 days to complete the credentialing process and then another 30-45 days for contracting.

What is Credentialing?

Credentialing is the verification of a provider’s information to ensure that they meet the criteria outlined in the company’s procedures to become an in network or medical provider. Typically this includes primary source verification of the following; License, DEA CDS, Medical Education, Training verification, Malpractice history, etc.

How long does it take to complete the credentialing process?

An application can be completed within 1-3 business days however, every insurance company varies in the time required to process new applications.

How often does our practice or providers need to be recredentialed?

Insurance companies typically re-credential providers every 18 months.

How often do we need to update our CAQH account?

It is imperative all credential information is current and CAQH application is re-attested every 60-90 days.

Can a CV be provided in Lieu of completing the provider application?

Yes, we are aware your time is valuable and will be happy to complete our provider application on your behalf, however we may require additional information the CV may not contain. Application will require providers review and approval.

What is Medical Licensure?

Medical Licensure is the authority to provide medical services in a particular state.

How long does it take to complete the Medical Licensing process?

Medical Licensure can take from 10-12 weeks however, there are factors that can delay the process such as verifying Professional history. High volume states and their processing time malpractice history, Disciplinary history, Convictions etc.

Is a FCVS application required?

An FCVS application is not for every provider. International providers receive the most benefits. However, some States have made it mandatory to create an FCVS application. The FCVS charges to create profile and to collect Transcripts and ECFMG Certifications

How long does it take to complete the FCVS process?

Creating a FCVS profile can take 3-5 months

Can individual packages be created to accommodate our practice needs?

Yes, we will work with you to prepare a package suitable to your facility needs.

How will my information be protected?

A SSL is used to protect all sensitive information by encrypting data.