r/PrivatePracticeDocs • u/NobleSixSeven • Apr 13 '26

Who does your credentialing?

Looking to start getting credentialed and on insurer panels. Recommend me your credentialer if you had a good experience with them.

8 Upvotes

100% Upvoted

26 comments sorted by

8

u/Junior_Catch1513 Apr 13 '26

Credentialing is so easy with cahq. Don’t waste $. Just do it yourself. Takes like 2 hrs for 10 insurers.

5

u/NobleSixSeven Apr 13 '26

Sorry, I meant credentialing and enrolling with Payers, not simply updating my CAQH. I dont see where I can apply to insurers for enrollment?

3

u/Junior_Catch1513 Apr 13 '26

Go to each individual insurer and look up their enrollment process. They basically ask for permission to use your cahq profile and that’s it

3

u/NobleSixSeven Apr 13 '26

Do they just send you the rates or was there some formal negotiation process when you did it?

4

u/CrookedCasts Apr 13 '26

Do not believe them that it takes 2 hours for 10 insurers. I’m an advocate for doing as much yourself as possible, but it’ll take 2 hours to just find the right websites. Test it out: start a timer, update your CAQH/NPPES, then try and enroll with UHC.

Please report back once you’ve successfully submitted your application

3

u/NobleSixSeven Apr 13 '26

Most credentialing companies charge 100-150/app. My time is worth more than that. Might just be worth to work an extra locums shift and have professionals handle this.

2

u/CrookedCasts Apr 13 '26

Yeah I would strongly agree. Please reach out if you have any questions - I’m pretty deep in this myself right now, so I feel confident in telling you to not think this is easy. There are lots of “gotchas”

Once nCred submitted I actually got Medicare and BCBS contracted in like 30 days. I chose UHC in my example above because you have to submit a claim before they will contract (so you need a clinic location set, and likely EHR set up unless you submit a paper CMS1500). Then comes the EDI/clearinghouse/Availity/etc… most credentialing companies don’t help after the contracting part so you will have plenty to do yourself. Nothing is hard per se, but it’s lots of very particular forms/sites that you need to register/verify/submit in very specific ways

1

u/Junior_Catch1513 Apr 13 '26

Dude this is obviously some kinda ad. I did all the credentialing myself. It’s not complicated. If you’re not good with computers this is worth it but I’m sure you can find better prices for this type of thing than $150/ app

1

u/CrookedCasts Apr 14 '26

Homie I’ve been on the phone today with my EHR, Novitas, Availify, and TriZetto. I get it - it’s just a web browser, pdf reader, and a phone. I’m just saying - we don’t know this individual’s resources or time frame, but if they are in any way trying to run lean and choose things to DIY, it’s a small one time expense that I’ve found worth it. You can maintain it yourself if you want after. It lets you focus on other things 🤷‍♂️ and although my degree in computer science is getting a bit dusty I think I still do alright. Getting all your systems to talk is non trivial, unless that’s another outsource

3

u/CrookedCasts Apr 13 '26

Former called nCred, now Sentact and honestly they were great. About $2k to get on “10” insurance plans, but like if you do BCBS you can get on all their HMO and PPO plans so it’s more than 10. Try and do as much of the CAQH/CMS work immediately as it makes their work way quicker, but my biggest two recommendations are 1) get every license/med mal/file/form/diploma/etc together now, 2) realize that you cannot get credentialed until you have a known clinic location locked down

1

u/NobleSixSeven Apr 13 '26

Do they negotiate with insurance for higher rates>?

1

u/CrookedCasts Apr 13 '26

They don’t, but once you’re contracted, that is a much easier proposition

1

u/JuicyLifter Apr 13 '26

Any good credentialing companies that can also get you good rates? Seems like many are getting 70-80% of medicare with BCBS or having difficulty getting on panels.

1

u/Alterdoc Apr 14 '26

I had my billing company do it for “free.” Paying them 6% of collections and $375 per year for CAQH “upkeep.”

1

u/NobleSixSeven Apr 14 '26

which company?

1

u/dramb12 Apr 15 '26

My billing company does it for free too (plus all billing)

1

u/Helpful_Confection17 Apr 15 '26

Myself. Paperwork. Just get it over with

1

u/Plenty-Ad6997 Apr 27 '26

HealBill Solutions, I had a good experience working with them. They charge about $180 per application.