Continuum Service Spotlight: Credentialing

Posted by Continuum on Apr 12, 2016 11:00:00 AM

A Quick Overview

Physician practices often underestimate the importance (and timing) of credentialing, the process of maintaining medical credentials and privileges for all providers. Continuum’s Credentialing team handles the initial licensure and all renewals, ensures that all providers are enrolled with payers and receive privileging at area hospitals, confirms National Provider Data Bank (NPDB) status, and tracks all items with regular expirations, such as malpractice insurance, certifications and licenses.

Advance Planning & Meticulous Records Are Key

During the second quarter of the year, Continuum’s Credentialing team often sees a flurry of activity, as practices hire providers completing their residency in June. A new provider will take approximately 120 days to credential from the time they complete their residency, since payers have no record of them in their system. If all required submission elements are ready and the licensing is granted quickly, the process could be accelerated to 90 days.

Providers obtaining credentials for the first time or who are joining a new practice should provide the following information:

  • CDS: A Controlled Dangerous Substance license (many providers are unaware this is required)
  • DEA number: The Drug Enforcement Administration number allows providers to prescribe medications
  • NJ License: New physicians or those coming from another state must have a NJ License, which generally takes a minimum of four to six weeks
  • Continuum also requests access to the provider’s Council for Affordable Quality Healthcare (CAQH) account, which allows the team to review existing documentation within the preferred database of most insurance companies
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Topics: credentialing, payer reimbursement

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