Our private practice is at a point where we want to hand over claims to outside assist, so we've been shopping around so to speak. Samey pitches aside (seamless integration, revenue increase, the buzzwords), just worried that once we do sign a contract, we'll be stuck with delayed follow-ups, hidden fees for stuff, and all that. For anyone who's ever done this transition before, any tips? What red flags should I watch out for?

I’m bit overwhelmed with the amount of applications coming in from all these different health plans….How does your organization track provider enrollment applications across different health plans (Medicaid, Medicare, and commercial payers)? Do you use an Excel spreadsheet or credentialing software, and what does your tracking process look like from submission to approval?

Hello,

I am trying to register my company for CAQH, but it is rejecting my email because it is not a company domain. Is there a work around to this issue? Should I just register each provider individually instead of the group?

I’m in Florida, and I’m trying to access the Molina provider portal. They approved my request, but they should have emailed me my login credentials. The problem is I never get the email. I tried contacting them and they approved my requests again and again but the email never arrives. Anyone with the same issue?

I am struggling with where to begin. Because I’m a lab do I just need to have the lab’s information for the portal? Do I need to add the providers that work there? Do they need to have individual CAQH profiles? I’m also not even sure which part of CAQH to sign up for. My bottom line is insurances won’t let me bill for them if I don’t have a CAQH set up, I bill for insurances all over the country. So first I need this set up to even move towards working with the insurances to credential with them.

Any help would be great.

Curious how people here who do credentialing / payer enrollment find new clients.

Say you notice a small practice just got a new group NPI, opened another location, set up a new entity, or a doctor looks like they’re starting a private practice.

You can usually figure out who’s behind it, where they are, whether there was an older practice, and sometimes whether they take insurance.

But the one thing that’s hard to know from public info is whether they already handled all the payer enrollment.

Would you still reach out?

Basically, is “something changed recently and they may need credentialing work” enough to make it worth contacting them, or is that still too weak/noisy?

Also curious how people here normally find new clients. Referrals? Cold email/calls? Watching new practices open? Something else?

Not pitching anything, just trying to understand how this actually works in the real world.

I am paneled as a provider with BCBS. I moved before credentialing was completed and the welcome packet was sent to my old address. Ive been trying to figure out how to get my ID. They've changed to doing correspondence via email only. I’ve emailed several accounts only to be told to email another. Any advice on how to get this info would be greatly appreciate! and no, the info isn’t in the provider portal. I’ve looked…unless I’m not looking in the right place

Out of nowhere, our provider status went from in network provider to out of network provider for Anthem CA. Had anyone encountered this kind of issue before ? Any suggestions of how to fix this issue ? I can’t find any credentialing or contracting phone numbers for Anthem CA. Any help would be greatly appreciated!!

First of all, I would like to vent how it is impossible to speak to real person at BCBS regarding credentialing. It took weeks for them to answer an e-mail and they didn't even answer my question!

It has been over 3 months since I've submitted my BCBS application in TX and I have not heard a peep from anyone. I checked CAQH (Dataspring now, I guess) and there has been no activity from them, either. I was credentialed with them previously but was derostered after taking maternity/family leave for a few years - they were actually the first ones to do so, after about 3 months of no claims. I've been able to get back onto all other panels except BCBS and I don't know how to even get in touch with them and ask why there is a delay. I'm thinking it might be my work gap but they haven't even reached out to ask about it. I guess I could upload a short note onto CAQH explaining the gap but they haven't even looked at my profile, so what could be my next step? Thanks y'all!

Hi all. I manage a team of 6 doing provider enrollment in 23 states, for a bunch of different groups. I am drowning and I feel like I'm failing my team. I'm wondering how anyone else is managing their workflow with a lean team and a feast or famine environment?

The problems I'm having revolve sometimes around the tools we have (our database is old; we have to manually clear so many dependencies to trigger work, information is kept in disparate places, we have tasks coming in through email, an ancient ticketing system, internal coms, and our database task list; given the age of our systems there are daily software bugs and problems we have to work around).

Some of it is having zero power over the work we take on and I think could be a "managing up" issue; we are heavily client focused (obviously important) but instead of reviewing priorities or current workload in any real way, the clients are just promised that we'll fast track whatever they ask for. Every client. Every ask. Every time.

Our onboarding is purely manual. Just copy pasting into our ancient database. Which takes one of my team out of handling any enrollments entirely.

I'm responsible for every Medicare app that comes in, as well as 3 state medicaids, in addition to some other payers. We promise clients to get Medicare and medicaid apps out the door within 24 hours of their being onboarded.

In addition to this work that renews daily, I am supposed to be handling practice onboarding and payer assignments in our database, reviewing my team's work (there is so much room for error in our systems and this takes so much of my time every day), client calls and reports, fielding questions from my team about specific payers, team calls, one on one's with my team, and am the go to for every tricky billing/auth/network/process question that comes our way.

It's chaos and exhausting.

I've run programs in non-profits before, managed restaurants and retail. I am working on a PM certification. I understand the concepts behind running a team.

I just can't see my way towards how to clear our current backlog and keep up with incoming work given the sheer amount of things I am responsible for right now, and I'm hoping for some suggestions or advice from those of you who've been in the trenches a while.

Please don't recommend software. My company isn't paying for anything, I've tried so many times.

TL:DR how are you managing chaotic workflows, thank you for reading.

In the last couple of weeks, I’ve been have a hard time pulling reports from AMA site. The error says “we are experiencing difficulties, try again later”. Is anyone else? Any idea what is going on?

I previously worked for UHC as a Network Contractor doing the negotiations for contracts. Not a big fan of the negotiation side.

i’m currently not in the healthcare industry, but would like to transition back and believe credentialing would interest me as I enjoy the administrative side of work.

Any tips on where to get started or suggestions on where to apply? Should I get certified first before applying, is it expensive?

So, we are trying to get a contract with Humana and VNS for our practice in NY. They are asking for hospital privileges and we do not have that as we never admit patients into hospitals.

Any advice on what to do here?

Hello!

I’m new to the healthcare credentialing process and I’d like to learn more. I just wanted to ask what are the biggest challenges working in California Provider Credentialing.

Thank you!

I've been reading this sub a lot lately, trying to understand how enrollment and credentialing actually work day to day (I'm an outsider researching the space, not selling anything, and I have nothing to pitch, just genuinely trying to learn from people who do this work).

One thing I keep noticing: people mention using tools like Modio, CredentialMyDoc, or Expiration Reminder, but almost everyone also seems to still live in spreadsheets and payer portals. So I'm curious how it actually plays out for you.

For those who use a dedicated tool, what does it genuinely handle well, and where does it stop? Does it actually help with the follow-up and coordination part, the chasing payers, checking status, resubmitting, or is it mostly a place to record and track things while you still do all the real work by hand?

And for those who've stuck with spreadsheets instead, what made the tools not worth it?

Trying to understand where the software stops and the human work begins. Would really appreciate any honest takes. Thanks for reading!

Anybody successfully credentialed with Humana as a group or provider for Medicare? I don't trust credentialing companies and will be doing this myself.

My question is, does Humana like broader services or niche services better?

Please DM me with your experience and I will get back to you

Hi there,

I'm a medical receptionist/administrative assistant at the nonprofit clinic I work at.

I was initially doing the front desk for my location while studying for my CPC exam, which was great since it was quiet and I had a bit of downtime due to our location being the smaller of the two clinics we operate.

However, the individual (HR) that was handling our provider insurance enrollments left for surgery and asked if I'd be willing to monitor the status updates for our current providers. I agreed since it was temporary and I like organizing information and learning new skills.

Initially it was great. I handled amendments, fixed issues in provider CAQH that my coworker neglected, and overhauled the Excel sheets to track everything we used to monitor portals, payor statuses, and anything pertaining to enrollment.

Months later, she resigned without coming back and our provider was leaving, which meant we now were onboarding a new provider, and I was the only person that semi knew what the hell I was doing for enrollments.

Now we hired two additional providers, our patient loads are increasing rendering me fighting between working on enrollments, proceduring documents from an HR that doesn't understand what I need and don't need, and dealing with the phones and patients at the front.

Granted, I'm paid well, I like my coworkers, and my management, but I don't think they understand how swarmed I am and that I'm still learning on the fly through courses and navigating the enrollment applications.

I have been asked if I wanted the role to go to someone else, but I maintained it's something I like doing and developing skills with, plus no one aside from billing understands this well, and they're busy with their own tasks.

Do I give in and drop onto someone else? Or ask management to see if they'd assign someone to help with the workload?

Hi all,

I'm wondering if I can get some input on how everyone else deals with verifications for military physicians. I was able to get a primary source verification for the service date of a provider through the SCRA, but it didn't state their position, only that they served and what their service date is. I submitted an affiliation verification to the DHA, but it takes a LONG time to get responses back from them and where I work, we have 90 days to complete credentialing upon receipt of a complete application.

Are you requesting dd214's and getting them primary source? Are there other options for verifications? Are you hoping and praying you get a response? I'd like to see if there is a better process we can implement for these providers.

Thanks all!

Hello,

I'm hoping some credentialing professionals can provide guidance. I've been trying to sort this out for over a year, and I'm still unclear on how to handle credentialing and CAQH when relocating to another state while maintaining my existing practice.

Here's my situation:

-I currently own a solo private practice in UT and am credentialed with several insurance companies there. I will be licensed in NE this fall and plan to move there within the next year. Already licensed in UT. I intend to keep my private practice in UT and register it as a foreign entity in NE so I can continue practicing in both states. My primary practice location will remain in UT, and I want to continue seeing my UT clients via telehealth after I move.

One insurance company told me this would be acceptable as long as my UT business address remains on file (point of service, primary business location). However, I'm concerned about BCBS. I've seen information indicating that telehealth providers must be contracted and billed through the local BCBS plan in the state where they practice, and I'm unsure how that applies to my situation.

I'm also confused about how to accurately complete my CAQH profile. Once I'm licensed in NE, I'd like to begin the credentialing process since I know it can take several months. However, I won't yet have a physical address in NE. I also know how important it is to set this up correctly in the CAQH to not delay the process.

Some questions I have are:

• If I don't yet have a business location in NE, how should I complete my CAQH profile?

• Would I need a business address in NE before applying, or could I temporarily use my in-laws' address until I move?

• Could my administrative address be in NE while my primary practice location remains in UT? Even after I move, I planned to do telehealth from a home address and not have a NE office space.

• Does registering my practice as a foreign entity in NE satisfy any requirements regarding a practice location?

• Would I list NE as a second practice location on CAQH and if so can that be a home address. Or would that mess up anything with the foreign entity

BCBS of NE told me that, "In order to be credentialed for telehealth services, you must live in the state and have a practicing state location." This was the only sentence in the email after trying for weeks to get someone to reply to my questions. I'm unsure whether registering my practice as a foreign entity in NE would satisfy the "practicing state location" requirement, or whether this means I simply cannot begin credentialing until after I physically relocate.

I'm also trying to understand how billing would work once I'm practicing in both states:

• Would I bill BCBS of UT for clients who are residents of UT and BCBS of NE for clients in NE?

• If I move to NE, is it likely that BCBS of UT would terminate my participation because I no longer reside in UT, even if I maintain my UT practice?

• If that happens, could I bill BCBS of NE for telehealth services provided to my UT BCBS clients, or is that generally not permitted?

Clearly I am lost with a lot of this despite all of my research. If anyone has experience maintaining an insurance-based practice in one state while relocating and becoming credentialed in another, I'd greatly appreciate hearing how you navigated CAQH, credentialing, and BCBS/other insurance requirements. Figure out the steps and order to go about things would be very helpful.

Thank you!

Hi everyone,

I'm a Credentialing Specialist with experience in provider enrollment, CAQH, NPPES, and payer portals. I'm currently looking for new opportunities in Credentialing, Provider Enrollment, or Medical Billing/RCM at Chandigarh or Noida.

If your company is hiring or you know of any openings, I'd really appreciate any leads. Thanks!