What is the duration of the credentialing process?
The turnaround time for credentialing varies by insurance carrier, so there is no definitive answer. Major carriers typically take 90-120 days to complete the process, while smaller carriers and plans may take longer.
When a provider submits a participation request to a commercial carrier, they must undergo two processes. The first is credentialing, where the carrier verifies all submitted credentials and presents them to their committee for approval. Once approved, the provider moves to the contracting process, where their participation is confirmed, and they receive their effective date.
It's important to note that commercial carriers do not permit retroactive billing. Providers will only be compensated for claims submitted after they are listed as "In-Network" in the carrier's claims system. Billing out of network can lead to significantly higher bills for patients, who may be responsible for covering the entire cost independently.