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Starting a practice

How to get credentialed with insurance companies

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Here’s what goes on behind the scenes — and how Headway’s relationships with insurance plans help us get you credentialed faster.

After a decade of schooling and supervision, hanging your private practice shingle should seem quick and easy. Yet the timeline for getting credentialed with insurance companies — and opening up your practice to thousands more potential clients — is far from simple, most of the time.

It’s crucial for an insurance plan to invest time in making sure the providers it directs its members to are capable of delivering high-quality care. Here’s what goes on behind the scenes — and how Headway’s relationships with insurance plans help us get you credentialed faster (all while negotiating higher rates!).

Why is provider credentialing important?

Every insurance company needs to verify that the healthcare professionals in its network have the adequate education, training, and licensure to care for its members.

Think about it: The insurance plan is agreeing to pay out for a portion of that care, so it’s critical that the plan does its due diligence to understand everything you’ve done to become the expert that you are. It also means its members — a.k.a your prospective clients — can trust the care they’ll get from you.

How long does it take to get credentialed with insurance companies?

Because each insurance plan’s credentialing team has different structures, systems, and processes, the credentialing timeline varies depending on the insurance plan. After you submit an application on your own, you can expect to wait 90 to 120 days before your credential is awarded.

Partnering with Headway can help shorten the insurance credentialing timeline: Thanks to our network, processes, and ongoing relationships with insurance plans, Headway is able to credential you lightning fast — typically, in around 30 days with most plans.

Instead of submitting separate applications to each plan, you can fill out Headway’s intake form just once and our operations team will start working to get you credentialed with every Headway-partnered insurance company in your state. And you’ll be able to track your in-network status at any time from your Headway provider portal.

Request a call with one of Headway’s practice consultants, and you could be seeing in-network insurance clients in a matter of weeks!

What does the credentialing process look like?

Each insurance plan has a separate application for provider credentialing, which you’ll need to request and submit individually if you’re taking on the work yourself. 

Here’s how it goes (without a partner like Headway):

  1. Research and identify which insurance companies you want to work with. Look at major payers in your area and specialty.
  2. Contact each plan’s provider services department to understand what’s required for credentialing, and to request a credentialing application.
  3. Gather the required documentation; this may include your license, proof of malpractice insurance, and DEA certificate, among other things. 
  4. Fill out each plan’s application thoroughly and accurately. You’ll need to provide your contact information, education, work history (including dates and locations of employment), and a history of any malpractice claims, and any other details the plan deems relevant. 
  5. Sign and submit your application, including any supporting documents.
  6. Follow up with each insurance plan to verify that they received your application, and stay in touch with the insurer throughout the process.

Many organizations leverage the Council for Affordable Quality Healthcare (CAQH) as a centralized way to quickly collect the details needed for credentialing. 

It’s important to check over the information you provide to insurance plans in the credentialing application, as any errors or omissions can cause your credentialing status to be delayed or even rejected. 

If this all sounds like a lot of work, you can let Headway streamline the credentialing process for you: After you complete Headway’s intake form, our credentialing team will be hard at work getting you credentialed with plans in your state, while you work one-on-one with your consultant to build your practice.

After submitting your credentialing application

If you requested credentialing on your own, you’ll want to periodically check in on your status with each plan.

It’s also a good idea to keep documentation of what was submitted on which dates, as well as a record of any follow-up conversations that occur as the plan processes your credentialing. If anything changes with your licensure, accreditations, or insurance policies, you’ll want to notify the plan and report changes promptly.

On the other hand, working with Headway helps cut down on the administrative work of following up with insurance plans: Our operations team can handle any obstacles that come up with insurance plans, and your private practice consultant will reach out if the plans need anything further from you.