Your Credentialing & Enrollment Expert

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Twenty years ago, payors had different credentialing applications for enrollment. They were often paper, filled out by hand and mailed or faxed to payers with the same 60 to 180 day processing times as today. In the early 2000s, several states implemented uniform applications which helped some the varying paperwork and CAQH was introduced as a single repository of information for providers to enter credentialing data and payers to recover it electronically. It took fairly a few years and over the past decade most major payers have adopted the use of CAQH but the processing time has not enhanced much, if at all, after all these years. Most credentials can be verified through electronic queries by a payer in a matter of hours while peer references and work history confirmation may take a bit longer.

Factors such as a payer union, missed re-credentialing notice, payer policies or changes may have impacted the status of your providers’ participation in certain plans.

Numerous options are available for practices to manage the workflow related to enrolling a provider in networks. CAQH is used more and more by payers as the key source of information to manage provider enrollment and credentialing and re-credentialing. It is imperative to keep provider information and documents up to date to avoid payer inquiries for missing information and the possibility that a failure to respond could lead to disenrollment of a provider and thus claims denials. CAQH is working on a number of initiatives to further improve the enrollment process. One of these is the CAQH Enrollment Hub where providers can manage EDI, EFT and ERA set up. While not all payers are accessing this yet, there are select payers now requiring this for certain functions such as electronic funds transfer. The login for the Enrollment Hub will work for the practice as a whole, rather than utilizing a provider-specific login.

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