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Thread Topic: Credentialing services

Topic Originator: Patricia Orr
Post Date August 31, 2006 @ 6:54 PM
Credentialing services Credentialing services

Credentialing services

Patricia Orr
Credentialing servicesAugust 31, 2006 @ 6:54 PM Reply  |  Email Friend   |  |Print  |  Top

Hello All,

I am new to credentialing and wanted to know if this will be a good service to add to my business?  How much should I charge.  I am thinking of marketing to new medical practices and found a site where you can purchase mailing list. (not sure if I can post the company name) but if you do a google search type in mailing list. I got a list of about 25 names for under $25.  some of the practices I contacted were really really new, they weren't seeing patient yet!

But about the credentially, I know what it is, but how hard is it to learn to do it?  are there any helpful site out there I can use?


Dan Young
Credentialing servicesSeptember 12, 2006 @ 1:13 PM Reply  |  Email Friend   |  |Print  |  Top

Hi Patricia,

Contracting can be complicated, especially when yu consider that your provider's livelyhood is based upon the negotiated contracts.  For example, an insurance contract might pay at 120% of Medicare allowable, but in the fine print they may state that they are only going to pay 80% of their contract to the provider.  For example, lets say a procedure pays at $85.00.  The insurance fee schedule is  80% of the 120%, which is $81.60.  You would'nt know this is if you didn't read the fine print.  You will need to have a grasps of the current fee schedules to know how to negotiate for your providers.  Also, what is the prevailing charge for credentialing in your area?  Some providers are getting soaked with charges into the hundreds, and others might pay as little as $50.00 for recredentialing, and $75.00 for new credentialing.

We charge our providers a discount for credentialing if we do their entire billing.  

Make sure you have a contract that protects you.  Remember the Golden rule:  CYA

Steve Verno
Credentialing servicesSeptember 20, 2006 @ 8:32 AM Reply  |  Email Friend   |  |Print  |  Top

Do NOT pay for a list of physicians.  There are many other ways you can get a list of physicians:

1)  Use Google or other internet search engine.  If you want a list of physicians in your area.  For example, I went to Google and typed "Orlando Physicians" and got more than 2,500,000 hits.  I went tjust one site and it gave me more than 124 physicians, practices and clinics just in the "A"s.  Each entry had the name, address and phone number.  Totally, it gave me more than 35,000 entries. If I paid what you wanted to pay, this same list would have cost me $35,000.  I got my list for free.

This site is called America At A Glance and the web address is:

You select a state, then you select a town or city.  You then select "physicians" and there is a list of physicians in that town or city.

2)  Go to the on-line yellow pages.  

I've been doing credentialing and health insurance contracting for many years now.  It's just like billing, you have to know what you are doing, otherwise, you will cause more harm to the physician than you could know.  I gave some advice to a friend and actually spent a week going over a proposed contract.  I made suggestions as to what to change and questions to ask.  They ignored what I recommended and they signed the contract.  Now, not one month in the contract, they are yelling for help because the insurance company is playing games with their claims.  I pointed this out to them before and warned them this would happen.  Well, now they're stuck with it.

I agree with Dan and I highly recommend this is an area you undergo training if you wish to pursue this.  One simple word in a contract such as "affiliate(s)" could cost you millions of dollars in revenue if not questioned and/or removed.

Credentialing servicesMay 20, 2015 @ 2:33 PM Reply  |  Email Friend   |  |Print  |  Top

Easy yes add, the more u no, the more u can add, like consulting for new providers who have no idea where to start, what insurances have good rate and what insurance you want to stay out of, maybe for reasons like, rate are too low or precert are ridiculous and almost impossible, some insurance can be good advertising to start out with, than they can get out later, keep moving up, the more you learn, the more u can offer, good luck

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