Newly Licensed Clinicians-Credentialing procedures

Rochelle Garcia 4 years ago in User Group Help updated by Mark Cornell 4 years ago 5


I was wondering if anyone would be open to sharing what their policy/procedures are when a practitioner transitions to be becoming licensed and needs to start their credentialing applications.  For example, do you have a conversation with them about how the process works and its the expectation that they complete the applications on their own or do you have a packet of information/steps for them to follow. 

My goal is to have some type of process written but I dont want to do every step for them either so im looking for ideas on how other agencies/clinics handle this.  I know some places may have a designated person for this but Im a 1 man band over here so anything would help.



We make it the providers responsibility.  We ask them to fill out to the best of their ability, we give providers a little tool that has the office address, phone, tax ID, etc.  Many of the applications are self explanatory other than Medicare, which we put tabs on the pages that the providers need to complete in the Medicare application.  Several of the insurance carriers we work with utilize CAQH so they need to create their account once that is complete we upload any supporting documents.  For the ones that require it to be completed online we do it for the provider as in the past they have missed or completed it incorrectly causing delays with their credentialing process.  Hope this helps.

I give them a list of insurance that do not use mncred (this assumes Minnesota) and it is their responsibility to complete the process.

We also do not increase their commission percentage until they complete the process because if we cannot bill them on their own then they need to continue to be supervised for billing.

Food for thought...

We are a small shop too, and have only credentialed one therapist other than our founder, so this is a bit of a new process for us as well. With that new provider, I gave her the links to the applications, and often walked through them with her over the phone to make sure everything was submitted correctly. Seemed to be a better option than something getting missed and having to go back and redo. I think your idea of a packet to give people is a good one, although I'm sure things will continue to evolve, so you will need to update occasionally. Thanks for asking the question... I appreciate hearing how others handle this too. 

We have a process typed up with directions for each different option (MCC, CAQH, BHP, DHS). We have them start with their PMI and have them come in to meet with our credentialing staff to go through the information once they have entered it in for all the payer options, so they can submit everything together. It is more a way for us to insure everything is entered correctly prior to submitting. We have NOT had any luck with the DHS portal, and are going to do the paper forms for the MHCP credentialing going forward. Has anyone else had any luck with the new portal?

I do appreciate the information about not increasing compensation until credentialing is completed in its entirety. That's an excellent incentive for them to stay on top of the process, instead of relying on credentialing staff to do that for them. Thank you for that, Mark!

With MCC, they have that great Audit option - which is so nice to make sure everything is entered correctly. I would definitely recommend they enter you (or whomever you are going to have oversee the credentialing) as the company contact. That way, when information requested is not received - payers will reach out to the company contact to get what they need. That will save a lot of time.

No problem, glad I could help.  This is such a mess of a process that I am glad you were able to put together some directions for it :)

Good Luck going forward and people here always seem to be helpful :)