What is the Credentialing Process – FAQ

What is The credentialing process?

The credentialing process is made up of two distinct processes, which are referred to as credentialing and privileging. Credentialing consists of primary source verification, which verifies a healthcare provider’s license, qualifications, and other pertinent information.

Privileging approves an individual to one or more procedures after they have submitted documentation of their qualifications to perform these procedures.

Provider Enrollment Applications, will begin the process of credentialing.

Some networks have set up an online provider enrollment application which can be submitted electronically. Once the initial application and supporting documents are submitted, the network will begin credentialing the provider. Most larger network will use CAQH as a form to verify information and gather supporting documents.

How long is does the credentialing process take to complete?

The credentialing process generally takes between 90-120 days. We begin immediately once you’ve come on board with RMS.

We make sure your credentialing applications are processed and approved as soon as possible. We follow up weekly with carriers to push for effective dates.

When should I begin?

Royalty Medical Solutions suggest that you begin your credentialing process anywhere from 90-120 days before your start date as a practitioner.

Starting the early allows an a safety net should the a respondent delay in their correspondence and protects you against any unforeseen circumstances.

Is there something I can do to accelerate the credentialing process?

Yes. A practitioner is able to accelerate the credentialing process by communicating with their verification sources requesting that each source replies to Royalty Medical Solutions in a timely manner.

Can I start seeing patients before credentialing is completed?

No, a provider is not legally allowed to see patients until they have received an “Approval Letter.” This contains the provider’s effective date and the ID assigned by their insurance company.

For this reason Royalty Medical Solutions recommends that providers start their credentialing process at least 90 days prior to their planned start date.

What is CAQH?

CAQH stands for the Council for Affordable Quality Health Care.  The CAQH manages a nationwide credentialing database utilized by healthcare providers  in order to simplify the  credentialing process. Most commercial carriers use the CAQH to confirm information while processing enrollments.

You can visit the CAQH official website for more information.

Can I have past effective date on the contract?

No. A commercial insurance company will never offer a provider a past effective date on any of their contracts. Additionally, Medicare prohibits all providers from submitted their enrollment applications less than 30 days before their start date.

What is PECOS?

PECOS  is an electronic system that can be utilized in order to submit a hard copy of the Medicare enrollment application (CMS-855).

  • Complete your Medicare enrollment application
  • Make changes to or view your enrollment application
  • Track the progress of your enrollment application
  • Make changes to or add a reassignment of benefits
  • Make changes to your current Medicare enrollment application
  • Reactivate your previous enrollment records
  • Withdraw from Medicare

Although paper applications are still currently accepted, we expect that they will shift to electronic applications in the near future. You can use your NPI username and password in order to create an account with PECOS.