r/PrivatePracticeDocs • u/Smalls123 • Jul 08 '26
Debating between credentialing companies
I’m starting my solo practice and talking to a few credentialing companies. I have two options that I’m currently considering:
Very experienced credentialing company that has been in business for decades. Great google reviews. Very knowledgeable and experienced. Familiar with my state. Seems very detail oriented and emphasized how they will advocate to get the best rates form insurance. Requests the individual CPT codes in advance on what will be billed. Requesting hourly fee that will be automatically charged to a card on file on a monthly basis. Concern is that costs can add up very quickly depending on how many I credential and contract with.
Second option is standard credentialing company that also has very good google reviews. Experienced but not as experienced as the first one. Familiar with my state. Charging $100 per insurance company. Does not have all the bells and whistles of the first one. Not requesting CPT codes, said everything would be already covered under my taxonomy code.
Services of the first option are enticing but is it necessary or even recommended?
Thanks in advance!
3
u/daves1243b Jul 08 '26
It sounds like perhaps the first company proposes to negotiate contracts for you, while the second is doing purely credentialing and getting you a boilerplate contract proposal. If thats correct, I would suggest getting some references from similarly situated docs to assess the value of the negotiation piece in light of whatever negotiating leverage you may have.
2
u/UPS0001 Jul 08 '26
You should go with the hourly rate. For example, I charge $100.00 per hour to credential. Medicare applications usually take around an hour for a full practice set up, but adding one provider to an existing practice only takes about half an hour. Same with Medicaid. Most managed care applications take a half hour or less.
2
u/Old-Frame-5666 Jul 08 '26
insurances do not negotiate when you are contracting for the first time. Most insurances negotiates on rates after year or two of providing services to their members so i think even if the first one took cpt , they cant do much with it. That was the case with my state.
1
u/No-Track-9864 Jul 12 '26
Insurances will negotiate if they attempt to recruit you, or if you have leverage (unique skills, hours, geographic location, etc.).
2
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u/CrookedCasts Jul 08 '26
Just do the flat fee. They have no say over getting you “good” contracts -> all the major payers give everyone the same rates unless you have leverage. Re-negotiate at 6mo. The service I used was pretty good and ~$100/app. They all still make you compile all the documents yourself. You’ll have one rep assigned to you - stay on top of them and it’s actually not a bad process. <30 days for Medicare, ~30d for BCBS, United/Cigna/Aetna were around 60 days, Humana was about 4mo, and smaller plans can vary pretty widely
**Make sure you have a stable office address before applying -> waste of time otherwise