Yes. RevCycle Partners requires a two-year agreement for its ongoing credentialing offering called “Maintenance Services.” The amount of maintenance work required each month can vary dramatically. Spreading the work and cost out over a 2-year contract creates balance for the practice and RevCycle Partners.

Payers that require contracting/credentialing are the ones that would be monitored under the Maintenance Service. Many practices also receive payments from life insurance, Medicare Advantage plans, or Third Party Administrators (TPAs), but those do not require contracting/credentialing. Credentialing with the Advantage Plans is included with the main payer, and revalidations would cover the Advantage Plans for the payer.

Unfortunately, RevCycle Partners cannot advise on which networks are open or closed. Networks can open and close at any time throughout the year. Networks can also be closed in small, very targeted areas. In many cases, the payer won’t indicate that a panel would be closed for a provider unless an application is submitted. In addition, a network may be closed for one provider and not another in the same area.

In network means the health care provider has contracted with an insurance plan and approved services are paid according to the contracted fee schedule. Out of network means the health care provider is not contracted with an insurance plan, and benefits will generally process under out of network benefits. This usually means higher out of pocket expenses for the patient.

It is the Council for Affordable Quality Healthcare. Yes, you must have a CAQH profile on file. A majority of the insurance companies use CAQH to confirm information that has been provided to them.

RevCycle Partners will verify and update information as required throughout the credentialing process. Having CAQH and PECOS access reduces paperwork and ensures timely receipt of information.

Depending on the reason for denial, RevCycle Partners will submit an appeal and/or request participation a second time, 3-6 months later.

Yes. RevCycle Partners has verified your information and completed and filed the necessary paperwork on your behalf. We cannot guarantee acceptance. That is solely up to the insurance company to determine.

No. For many insurances, being credentialed means you can see patients, but it will pay as out of network.

Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy. Credentialing is required for most insurance companies to be contracted. Contracted means you are an in-network provider and have a signed agreement to accept patients for an agreed fee for service.

No. All contract negotiations and fee decisions are the responsibility of the practice.

RevCycle Partners will update information as it’s received from the insurance companies. You can login to your portal account to access any updates noted at any time. RevCycle Partners will provide updates at least once a month.

If the insurance reaches out to you or sends you any documentation, it is imperative that you notify a credentialing team member immediately. Failure to forward information from the insurance causes delays. It can also mean having to start the application process over.

The timeframe all depends on the payer. Some will complete applications in 30 to 60 days. Generally, you should expect the process to take up to 120 days, sometimes longer. We experienced significant delays on payer responses during Covid, and many payers have not caught up yet. Contracting can take an additional 60 days. There are variations in time depending on insurance and reasoning, it can mean shorter and/or longer time frames.

All doctors expecting to receive reassignment of benefits as a participating provider for claims, must be contracted with the insurance plan, and therefore require credentialing. The amount of time or hours the provider works is not applicable to this requirement.

If you are joining a practice within the same state, and you are already participating with payers, demographic updates will take care of linking you to your new practice.If you are joining a practice in a different state, full applications will apply.If you are purchasing or opening a new practice and are establishing a new NPI/Tax ID/company name, brand new credentialing will be required for the EIN, and you may need demographic updates to link yourself to the Group.RevCycle Partners will look to perform the credentialing project in the most efficient and cost-effective manner.

If you are opening a new practice, or if you are adding a new provider to your practice, the credentialing process can begin 60 days before the practice opens, or 60 days before the new provider starts.If the new hire is a new graduate, they will need their license, insurance, and CAQH set up before the credentialing process can begin.