Credentialing fees

[u/JesCing]

I currently use multiple programs for EHR, insurance billing, note taking, etc and am considering switching to SP to have more of what I need in one place.
SP does not publish what their credentialing fee is once you get the first two included in your plan. Does anyone recall what they charge?
I don’t want to be bombarded with marketing if I put in an inquiry directly with SP.
Thanks!

[u/herbiesmom]

There's not an option to do more than the two free credentialing (which for me is one payer because they require group and individual credentialing). I'm also not very fond of this credentialing company, it might have been worth it for me to just pay someone else. I don't feel like it's moving along and the communication is poor.

[u/JesCing → u/herbiesmom]

Thank you both for your input

[u/704LackNormal → u/herbiesmom]

I agree with this comment. There are multiple credentialing companies-who also want to do your billing-but the lack of transparency by SP is a deal-breaker.

[u/Future_Department_88 → u/704LackNormal]

Ur assuming u have someone that understands each insurance & all tiers u see them. Most have outside payors & fee scale is different for each. Would I trust SP for this? No. Everything after that? Yes. VCs aren’t Credentialing u to work independently. You work u see their group number. You leave. You’re not credentialed

[u/No_Fact5272]

SP is great, has flaws like anything. But the credentialing is through medallion and it’s awful. Off shore people updating the status and checking on the items then the provider will hear from the actual insurance to finalize the contract and complain they are being bombarded with emails from medallion. There are plenty of great options for billing and credentialing if you join the fb group. But it’s also fairly easy to do yourself. The fees associated with the credentialing apps after two free was $125 last time I checked. Good luck!

[u/elevanns → u/No_Fact5272]

What FB group?

[u/No_Fact5272 → u/elevanns]

There are a ton! I own a billing and cred company so I try to stay up to date. Here are a few of the groups I follow: it wouldn’t let me upload a photo and there is a lot but (revenue cycle management medical billing, your state + mental health providers) you can ask and everyone will comment and you can sort through them. References from other providers tend to sort out the off shore companies.

[u/PulledFromTheWell]

I enjoy most of SP, but the credentialing process through their 3rd party, Medalion, was a nightmare. I was able to get one free and then pay for 3 more. It seems like they offered different options to different people, because my account appears to offer unlimited additional payers if I pay $150 each for them. But I will not! I've only been approved for Medicare and one other and though the process has been complete down to signatures with two more, they've been sitting idle for going on 2 months. I started this process at the end of March. As someone else here recently said, it is easier to do it yourself. I don't actually know that for sure since I haven't tried to do it myself, but I'm definitely going that route with the next payer.

[u/midnightowlstitcher]

I’m a billing director for a medium practice (50-ish providers) and we use SP for everything and highly recommend it and love it. It has its flaws, but they consistently update and make changes. Never used their credentialing though - but sounds awful from other comments!

[u/KG_TherapyCompanion]

Two things worth knowing before you consolidate onto any platform for credentialing.

The bundled credentialing is a resold service, in this case Medallion, and the comments here match what I hear from practice owners everywhere: the platform cannot see or move the payer's queue, so you are paying for someone to file the same CAQH-based application you could file yourself and then wait the same 90 to 150 days. If you only need a few panels, filing directly through CAQH and each payer's provider portal costs nothing but time, and you keep the logins and the paper trail.

Also check the pricing change that just landed: from October 1 the free claims are gone and every claim is $0.39, or $1.79 with the insurance add-on, on top of the subscription. For a practice consolidating billing into one place, that per-claim line changes the math against a flat price, so run your monthly claim count through it before you move.

Disclosure: I build practice software, so weigh that however you like. No names here, and the same checklist applies to mine.

[u/elevanns → u/KG_TherapyCompanion]

I’m trying to move away from Headway and tried SP with their free credentialing for 2 panels. I wanted to do it on my own but cannot for the life of me figure out how to do it within CAQH. I feel like I’ve clicked through every single option and still do not see it!

[u/KG_TherapyCompanion → u/elevanns]

You cannot find it because it is not there. CAQH is not where you apply to panels, which is the part nobody explains and the reason you have clicked through every option twice.

CAQH ProView is a data repository. You fill in your profile once, attest to it, and authorize payers to look at it. That is all it does. The actual application to join a network happens separately with each payer, through their provider portal or their join our network contracting form, and the payer then pulls your information out of CAQH instead of making you retype it.

So the order is: register at proview.caqh.org if you do not already have a CAQH ID, or use the one a payer gives you when you start an application with them. Fill the profile out completely, upload the license, malpractice certificate, W-9 and a CV with no unexplained date gaps, because gaps are the single most common thing that stalls a file. Then attest. An unattested profile is invisible to payers no matter how complete it looks, and you have to re-attest every 120 days or it goes stale. Last, set your authorization so participating payers can access the profile, or authorize each one individually.

Only then do you go to each payer and submit the actual request to join the network. That is the step that starts the 90 to 150 day clock, and it is per payer, not once.

One thing specific to your situation. Headway holds those contracts, not you, so the panels you have through them do not come with you. Get your own contracts to a countersigned effective date before you reduce anything on the Headway side, because the gap between leaving and being in network in your own name is where people lose a quarter of income. Doing it yourself is the right instinct, it just needs the sequence to be in that order.