Upcoming Conferences
Provider/Clinic Credentialing
Initial Up-Front Needs: Prior to reaching out to insurance payors.
START THIS PROCESS AS SOON POSSIBLE, CREDENTIALING CAN TAKE 60 T0 90 DAYS TO COMPLETE AND INSURERS DO NOT BACK DATE.
WATCH THE LOCATION OFFICE EMAIL FOR THE CONTRACTS OR REQUEST FOR MORE INFORMATION FROM THE INSURANCE CREDENTIALING DEPARTMENTS. TIMELY RETURN OF INFORMATION IS KEY TO FASTER CREDENTIALING AND EARLIER EFFECTIVE DATES.
CAQH: (www.CAQH.org) / Update CAQH completely for a provider, prior to sending for credentialing. Insurance payors use the information in CAQH, and it must be current.
Provider:
- NPI (WWW.NPPES.GOV)
- Medical License
- Malpractice Insurance
- Demographic Sheet that includes.
- DoB
- SSN
- CAQH Login and Password
- Update CAQH profile with new clinic information
- List of current participating insurance payors
- Contact Phone/e-mail.
CLINIC:
- Level 2 NPI
- Malpractice Insurance
- Demographic Sheet that includes.
- Location address, phone, fax
- Pay to location address, phone, fax.
- Location (appointment) phone number
- Location Fax Number
- Location Contact Information (name, phone, fax, email)
- Tax-ID
List of Payors that clinic wishes to participate with to see patients as In-Network.
I.e., Blue Cross Blue Shield of NE, NE Medicaid, Medicare, Humana, United, Aetna
BCBSNE: Credentialing Information for Providers | BCBSNE (nebraskablue.com)
NE Medicaid: Provider Screening and Enrollment (ne.gov)
Medicare: Welcome to the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) (hhs.gov)
Humana: Join Our Network – Humana
United Healthcare (UHC): Join our network | UHCprovider.com