Introduction
Credentialing is a crucial step for any healthcare practice. It ensures you are properly enrolled with insurance payers, allowing you to serve patients and get reimbursed for your services. However, mistakes in the credentialing process can lead to significant financial losses, operational setbacks, and reputational damage. Below, we’ll cover five common credentialing mistakes and how to avoid them to protect your practice’s revenue and success.
1. Incomplete or Inaccurate Applications
Missing or incorrect information on credentialing applications is one of the most common mistakes practices make. A single oversight, such as an outdated license or incorrect Tax Identification Number (TIN), can lead to delays or outright denials from payers.
How to Avoid It:
Double-check all application details and ensure every document is up to date. Working with an experienced credentialing specialist can significantly reduce the risk of errors.
2. Delaying the Credentialing Process
Many practices wait until they’re ready to start seeing patients to begin credentialing. Unfortunately, the credentialing process can take months to complete, meaning delayed reimbursement and revenue loss.
How to Avoid It:
Start the credentialing process as early as possible, before your providers begin seeing patients. This proactive approach ensures your practice is ready to bill payers without delays.
3. Not Following Up with Payers
Credentialing doesn’t end when you submit your application. Many applications require follow-up to address additional documentation requests or to resolve issues. Failing to monitor the progress of your credentialing application can lead to delays or even a closed application.
How to Avoid It:
Keep track of all submitted applications and set reminders to follow up with payers regularly. Partnering with a credentialing expert ensures consistent communication with payers.
4. Overlooking Re-Credentialing Deadlines
Credentialing is not a one-time process. Providers must undergo re-credentialing every few years to maintain their payer contracts. Missing re-credentialing deadlines can result in deactivation, leading to denied claims and lost revenue.
How to Avoid It:
Maintain a detailed schedule of re-credentialing deadlines for each provider in your practice. Automate reminders or delegate this task to a credentialing team to ensure compliance.
5. Neglecting to Verify Provider Information
Provider details, such as National Provider Identifier (NPI) numbers, malpractice insurance, and work history, must be accurate and consistent across all payer applications. Discrepancies can lead to delays, claim rejections, or even audits.
How to Avoid It:
Create a standardized process for collecting and verifying provider information before submitting applications. Regular audits of your records can also help identify and correct inconsistencies.
Why Credentialing Matters for Your Practice’s Bottom Line
Credentialing errors can result in:
- Lost revenue due to denied claims.
- Frustrated patients unable to use their insurance.
- Damage to your practice’s reputation and operational efficiency.
By avoiding these five common mistakes, your practice can ensure a smooth credentialing process, avoid financial pitfalls, and focus on delivering quality care to patients.
Let Us Handle Your Credentialing Needs
At PCH, we specialize in comprehensive credentialing services tailored to healthcare practices. With over 15 years of experience, we take care of the details so you can focus on growing your practice. Contact us today to learn how we can streamline your credentialing process and help you avoid costly mistakes.
Optimize your practice—because every dollar matters.
