How quickly do commercial plans credential solo doctors?

Originally published by Ho Sun on December 25, 2010

I received my official approval letter for Blue Shield of California yesterday.   I mailed in my application on December 14.  Once again, I’m amazed how fast my private insurance credentialing has been going.  I still won’t be able to accept patients until my contract gets processed in about a month or so.

I feel so fortunate that I probably won’t become one of those credentialing disaster stories.  Of course, nothing’s been finalized yet, so never say never.

I think part of the reason that my insurance credentialing has gone so smoothly is because I have a short and clean practice history.  Also, applying in the offseason probably helped as well.  I would bet that credentialing departments will start seeing a large backlog in the Spring when graduating residents start applying.

Also, maybe the California plans don’t take as long as national plans because of the lower volume of applications.  Who knows.

Despite my luck, I think the key to fast credentialing is to have a complete, error-free, application on the first go.  My guess is that any missing or erroneous information will get your application at the bottom of the pile.  Also, the biggest delays will probably come from time lost during the resubmission process. Without a doubt, online applications are the way to go if you want to maximize your chances of getting credentialed in your first shot.

I’m just waiting on Cigna now.  After that, I should be good to go.

Howie’s addendum:

How quickly you credential depends on what state you’re in. Don’t forget to read Ho Sun’s excellent post about Medicare credentialing as well as my tips for credentialing (hint: do it yourself, definitely don’t hire a company, if anything find a trusted family member or friend), CAQH for commercial plans, and Medicaid credentialing, if your state’s rate justifies it.

Here’s my experience in Arizona:

BCBS: within one month

Aetna: told me network was full, then when I told them I wanted to change TIN and address, got the contract within one week. About two months in all.

Cigna: two months

UHC: this was a pain. Had to keep on phoning them because some documents got shuffled around and it took 4.5 months, a few weeks after I opened doors.

Health Net: kept on telling me network was full, finally joined through my IPA and even this took forever. About six months in all.

Medicaid plans: two of them within two months, one through my IPA (see Health net) and the biggest plan in my state took me about a year to get on.

Certain Medicare advantage plans: three to four years after I opened, through my ACOs or other methods.

The process never ends, and it doesn’t hurt to keep trying. Don’t stress out too hard if you can’t get into every single plan before you open, but being on Medicare is a must (for ophthalmologists as this is most of our patients), and it helps to be on the bigger ones in your area, usually BCBS, UHC and Aetna, before you open doors.

2 thoughts on “How quickly do commercial plans credential solo doctors?

  1. Hi, awesome blog. I got confused about the part you said you told Aetna about the TIN and address change and you got the contract. Thanks

    • When I applied to Aetna via their website as a new provider they sent me a rejection letter telling me their network was full.

      When I phoned provider services to tell them I was a existing doc who wanted to change my TIN and address I got the contract the next day. Obviously working in the area and already being credentialed helped me, but even if I hadn’t I would’ve eventually got in network.

      I had a similar experience with one of my Medicaid programs, the rep helped me get in network because I was an existing doc despite a different TIN even though the panel was closed.

      If you work part time in another practice it usually doesn’t automatically transfer over you have to recredential with a new TIN.

Leave a Reply