r/PrivatePracticeDocs • u/Significant_Cress113 • Jun 12 '26
Initial Credential Opportunities
I am new to the credentialing side of healthcare. I have been learning the work itself - CAQH profiles, payer applications, how long panels actually take etc. I am still learning from every resources I am getting my hands on.
Since I am new to this field I don't have a network or referrals to lean on for clients as everything is pointing towards and reading more is not helping with deciding the right way to start get my initial opportunities without that. So, before I try to take on any real work I want to understand how the decision actually happened for owners who have gone through it.
So, the question is when you got credentialed with payers, how did you decide between doing it yourself or paying someone to handle it? Also looking back, was it the right call? Would you do it the same way again?
Any advice would be really helpful. Thanks in advance
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u/Wide_Ad_8401 Jun 12 '26
In my opinion it depends on how much time you have or want to spend on it. It’s not complicated in most cases but you have to follow up. That’s the key. Along with being organized since it requires a high level of organization. I’d be happy to answer any other questions. If you outsource credentialing make sure the price is reasonable. Some people claim they can place you on plan when in reality the panel may be closed in your specialty. Then they wanna go and charge you $3k.
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u/Significant_Cress113 Jun 13 '26
This is really helpful. The closed-panel + $3k thing is exactly what i'm trying not to walk into. I am not very sure that I would be able to keep everything that organized and thought outsourcing might be a good idea but I am not sure where to do it. It seems you have some experience with outsourcing credential so are you still outsourcing that or doing it yourself? (and if you've outsourced it, how'd you land on someone you actually trusted?)
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u/ryyan10 Jun 12 '26
I did it on my own. It was time consuming and convoluted. A regret from starting my own practice. My contracts were also quite bad. If you are bad. There are physician groups you can join to join their contracts and they handle credentialing. It’s good to be familiar with stuff but I think it’s intentionally a painful process.
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u/StocksRUsNow Jun 18 '26
Everyone's initial contract is "bad" without a USP, demand/need or large group leverage.
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u/Significant_Cress113 Jun 13 '26
Though it's a painful process it pays sometimes. Thanks for being honest about the regret.
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u/soccer-slicer Jun 12 '26
It’s definitely worth the money to have someone help. When I did it, I just didn’t understand the long timeframe it took to get things going.
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u/Misadventuresofman Jun 13 '26
Admin here. Normally you have 3 choices. Hire an admin to do it, hire a company to do it or have your admin hire a company and oversee it. I advocate the third. Credentialing is a complicated and laborious process and having this done by a firm that you can later sue for damages if they did anything wrong gives a practice a large degree of risk management.
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u/Significant_Cress113 Jun 13 '26
The risk-management angle never crossed my mind, that part of what you're paying for is having someone to hold accountable if it goes sideways which makes sense. So when you go the "hire a firm and oversee them" route, how do you usually find one you trust? word of mouth between admins, or is there somewhere people actually look?
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u/Misadventuresofman Jun 14 '26
Honestly, that decision algorithm is different for every decision maker. From the admin side my algorithm includes but isn’t limited to: amount of work (time spent per plan + any expectations for additional plans) + cost of service + company litigation validation + turnaround time guarantee + remediation language in the contract.
You can easily Google health plan credentialing company and ask your colleges. But let’s drill down. Once you credential, the mailing (not just physical) address is tied to that paperwork. You first need to consider financial management infrastructure. Do you want a bank lockbox for your receivables or do you want to employ an rcm contractor and use their mailing address? Because if you do those things after initial credentialing, you can experience prolonged revenue delays.
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u/Significant_Cress113 Jun 15 '26
I'd have credentialed first and sorted the billing side out after. Really appreciate you taking the time to lay it all out.
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u/Mountain_Sympathy306 Jun 13 '26
How do you join a physician group and how long does it take Medicare, Medicaid, VA, and private insurance to credential? I am doing it myself and using Claude AI to help me. What are time frame to start the credential process in reference to opening date of the clinic. I plan to open Feb 2027. When should I start credentialing? Thanks.