AddVal, Inc. | Unrivaled Medical Credentialing Expertise!

Difficulties with New Hires Defy Logic and Reasoning! !

When your practice hires a physician who is finishing their training this summer, the lack of logic and reasoning in the credentialing process manifests its ugly head! First and foremost, the state licensing process and all hospital applications should begin as soon as the hiring decision is made.

Unfortunately, the commercial insurers and Medicare will only accept the credentialing forms 30 days before the physician’s start date. If the forms are submitted earlier, they are rejected & returned. This would imply that the insurers would complete their credentialing processes within the 30 days but this is not the case. Medicare is the “kindest” in that they will process the application with the requested effective date so that once the processing is complete, all Medicare claims can be submitted for patients seen after the start date. This does create a cash flow problem for your practice, but, at least the claims will be paid.

The commercial insurers are not as “kind”. The effective date will be assigned when they complete their credentialing and contracting processes. Our average time for approval is 83 days – if the new physician sees patients with the commercial insurers before the assigned effective date, the claims may be denied or paid at the out-of-network rate. As a result, it is recommended that new physicians be scheduled for Medicare patients only until the credentialing and contracting for the commercial insurers is completed. As a general rule, CIGNA credentialing is the quickest (about 35 days) and United Healthcare is the longest (5-6 months).

It would be wonderful if the process was more logical and reasonable for all concerned. However, AddVal can work with you to be sure your new physician is credentialed as timely as possible given all of the constraints listed above.

If the physician you are hiring is already in practice in your area, the credentialing process is much different and is handled separately – call us today for help with adding physicians who are already in practice.

Health Plans Are Expanding…

With the Affordable Care Act implementation, many of the health plans are adding products for the exchanges and many are adding Medicaid products as well. In some cases, unique networks are being created from existing plan networks and in other cases, special contracts are being written for these new products. Every insurer and state are handling the process differently. We are assisting our clients with the information needed for their specific situation – current participation with a health plan does not guarantee that your practice is included in the new products – be sure to investigate each situation carefully.

Remember….
“There are far, far better things ahead than any we leave behind.” --Ralph W. Emerson


If you need any help with Medicare credentialing or credentialing with any commercial insurers, or you are concerned about Medicare Revalidation please contact AddVal for assistance at 215-396-8972, mmcfarla@addvalinc.com.

About Add Val, Inc.
AddVal, Inc., based in Southampton, PA, currently serves over 5,000 clients across the U.S., providing experienced medical credentialing services. The company employs a unique blend of talented individuals experienced in clinical administration, healthcare insurance and medical credentialing. This team, combined with a singular focus on credentialing, produces unrivaled results for clients.

AddVal, Inc

Unrivaled Medical Credentialing Expertise
AddVal, Inc.
607 Lakeside Park
Southampton, PA 18966

Telephone: 215-396-8972    |    Fax: 215-364-2187    |    Email: mmcfarla@addvalinc.com