Nurse Practitioner Credentialing Services
The nurse practitioner (NP) credentialing process can be time-consuming and complex. Our credentialing services alleviate the burden of navigating credentialing and enrollments across various insurance companies.
Credentialing for Nurse Practitioners
Credentialing is a process that healthcare payers use to evaluate and qualify providers. Insurance companies review academic qualifications, nurse credentials, and their history of clinical experience. The process and requirements vary across different commercial and federal payers, complicating the process, which can delay payer contracting.
However tedious, getting credentialed as a nurse practitioner is required to bill insurance providers and government agencies. Scope of practice, state licensing, and specialty can all impact what privileges you have as an independent provider. Accurate and efficient credentialing helps you to understand what services can be provided in your NP clinic, and how much you can bill for these services.
Benefits of Professional Credentialing Services
Medical credentialing with health insurance companies in the United States can be tiresome and discouraging. Partnering with insurance credentialing professionals removes the burden from your shoulders so you can focus on patient care.
Narrows Your Focus
Credentialing is one of the first steps in entrepreneurship. Outsourcing credentialing allows you to focus on business planning and other activities.
Our credentialing professionals have experience working with a number of healthcare organizations. They have the know-how to navigate the application process.
Managing data and documents for credentialing applications across your payer mix is faster and less prone to errors in the hands of experienced consultants.
Credentialing Services for NPs
Assessing Practice Needs
We’ll assess your payer contracting, credentialing and enrollments to identify your practice’s needs. This includes payer analysis, review of onboarding and offboarding processes, CAQH (Council for Affordable Quality Healthcare) profile updates, internal workflows, and software or database analysis.
Depending on the type of organization and your requirements, we will create processes that work for you and your staff. Our tenured operations consulting team will build the solution your independent practice needs.
We’ll manage processes including name changes, new software installation, demographic updates, credentialing renewals, and assistance on credentialing–related insurance denials.
Most payers have unique requirements you’ll need to meet for success. Our experts will identify your ideal payer mix, working through their individual processes to get your practice ready quickly.
Ready to Improve Patient Care Together?
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Opening a New Practice: Credentialing Requirements
When opening your own clinic as a nurse practitioner there are many decisions that need to be made.
- What EHR should you choose?
- How will you attract new patients?
- How do you pick a location?
- Should you accept insurance?
With so many choices to make and things to do, nurse entrepreneurs can find themselves feeling overwhelmed. Often, new practice owners opt out of credentialing payer contracting simply to avoid adding one more thing to their checklist.
However, more than 90% of people have coverage through a health plan, according to the US Census. Choosing not to accept insurance greatly limits your ability to attract new patients.
Before you can begin credentialing, you’ll need to:
- Secure a Tax ID Number from the IRS
- Acquire a Group NPI (Type 2)
- Update your CAQH (Council for Affordable Quality Healthcare) Account
- Register for a business bank account
- Obtain medical malpractice insurance
- Select a location
Once these items and any other payer-specific requirements are met, the credentialing process can begin for your independent practice.
Licensing and Credentialing in New States
Many entrepreneurial NPs start telehealth private practices. Others launch brick-and-mortar clinics that offer telehealth services in addition to in-person care. In either scenario, relocation or expansion across state lines requires careful planning.
Business owners will need to secure their state nurse practitioner license. Then, they can begin the credentialing process with payers in their new state.