Medicare and private insurance credentialing: timeframe

By Preeti Narayan, MD All Posts 0 Comments

The credentialing process, technically called enrollment for Medicare, can vary in time frame depending on a few factors:

Application type: Different enrollment applications for Medicare have different processing times.
Generally, individual and new practice applications take 60-90 days, while DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies) or Part A (institutional settings) applications can take up to 120 days.
Completeness of application: Ensure your application is filled out thoroughly and includes all required documentation to avoid delays due to missing information.
Medicare intermediary: The processing speed can vary by state depending on the Medicare intermediary handling your application.

Here’s a general breakdown of processing times:

Officially: Medicare advises allowing up to 120 days for approval.
Realistically: You might see approval much sooner, with some applications being processed in as little as 45 days.

Tips for a smoother process:

Submit a complete and accurate application.
Follow up with the Medicare intermediary if you haven’t heard back after a reasonable amount of time (around 60 days).
You can check the status of your application online through PECOS (the Medicare enrollment system).

The credentialing process for private and commercial insurances can take anywhere from 90 to 150 days on average. There are a few factors that can influence this timeframe:

Insurance company: Different insurance companies have their own internal procedures and processing speeds.
Application completeness: A complete application with all necessary documentation gets processed faster than one with missing information.
Provider type: Credentialing for some specialties might involve additional requirements, potentially extending the process.

Here’s a quick comparison:

Private insurance (e.g., BCBS, Cigna): Typically takes around 90 business days.
Government programs (e.g., Medicaid, Tricare): Can take longer than private insurance, sometimes exceeding 150 days.

Tips to expedite the process:

Gather documents beforehand: Have all required documents like licenses, certifications, malpractice insurance details readily available.
Follow up regularly: Check in with the insurance company periodically for status updates and address any missing information promptly.
Consider a credentialing service: Credentialing companies can help navigate the process and ensure a smoother application journey, although their services might come with a fee.

By being prepared and proactive, you can increase your chances of a faster credentialing experience with private and commercial insurances.

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