Posts by tgeddes

For most practices, CAQH credentialing is where commercial payer credentialing starts. Payers pull a provider’s education, licenses, work history, malpractice coverage and practice locations from the provider’s CAQH profile instead of asking for the same documents again. When the profile is complete and current, payer credentialing moves. When it lapses, every payer reviewing that provider…

Nurse practitioners and physician assistants now deliver a large share of patient visits in many practices. But a new NP or PA cannot bring in revenue until their credentialing is complete with each payer the practice bills. Credentialing nurse practitioners with insurance companies follows the same basic steps as credentialing a physician, with a few…

Medicare provider enrollment is the step that lets a group practice bill Medicare for the services its providers deliver. For a single physician it is one enrollment application. For a group, it is a chain of applications that have to line up: the practice enrolls as an organization, every provider enrolls as an individual, and…