Q. Why do healthcare professionals need enrollment (commonly referred to as “credentialing” and “re-credentialing”)?

A. Being enrolled to participate with healthcare insurance companies means you have become a part of their network or panel of providers, who can bill those companies for the services you render to their policyholders or members.  Being a part of the panel/network will greatly increase your exposure and increase the number of patients who can access your services, which will help to build your practice.

Q. Do I get to choose the insurance panels I want to be on?

A. Yes.  You may already be participating with some healthcare companies or choose to only enroll with specific companies and their products.

Q. What if I don’t know which healthcare plans are in my area and are best for my practice?

A. We can help!  Credentialing Specialists, LLC will meet with you to discuss the best selection of available companies in your area/market and which would best fit your specialty and practice.

Q. What are some of the most popular insurance companies?

A. The popularity of insurance companies varies depending on location in each market.  However, some of the most popular and largest companies which are also in the Florida market are Florida Blue (Blue Cross Blue Shield), Aetna, CIGNA, United Healthcare, Humana, Simply Healthcare, Sunshine Health, etc.

Q. How long does the enrollment process take?

A. The enrollment process generally takes 90-120 days (maximum 180 days), depending on the insurance company.  With contract negotiations and language changes, it could take an additional 60 days. Once hired, Credentialing Specialists, LLC will waste no time getting your applications completed and submitted.  We follow up to make sure that your applications are being processed and approved as quickly as possible.

Q. Is the healthcare provider’s documentation and information secure?

A. Credentialing Specialists, LLC is HIPAA compliant, and strictly follows NCQA guidelines regarding confidentiality of records and their storage.  A signed Confidentiality Statement is provided, prior to beginning the enrollment process.  The healthcare provider signs an Authorization, giving the applicable personnel/entity permission to release their information required to complete their enrollment process.  All information submitted for enrollment purposes, will be securely stored and destroyed 12 months after completion of the signed contract for services between the provider and Credentialing Specialists, LLC.

Q. Do you have experience enrolling providers in any specialty?

A. Our team has over 18 years’ experience negotiating and enrolling various specialties and Primary Care providers.  To name a few: Family and Internal Medicine, Cardiology, Nephrology, Urology, Behavioral Health (Psychiatry, Psychology, LCSWs, Interventional Radiology, etc.).  No matter what your specialty is, if you are eligible and the network is willing to provide a contract, we will get you enrolled!

Q. Am I guaranteed to get on the panels I choose after hiring Credentialing Specialists, LLC?

A. If you are fully licensed with no adverse actions, we should have no problem identifying many insurance companies and possible third-party payor networks for your enrollment and participation.  Some companies can be very selective based on specialty, geographic saturation or closed panels.  In these instances, we will speak with you about the likelihood of a successful enrollment process for the chosen company or companies.

Q. What if the insurance panel I want to be enrolled with is closed?

A. Finding a closed insurance panel is frustrating, especially when their members contact you for care. Credentialing Specialists, LLC will be relentless with its attempts and appeals submitted on your behalf for participation.  For example, we will then stress the importance of your qualifications and the benefit of your clinical practice to their network and members.  If you have a rare specialty that the insurance company desires, or you are practicing in a neighborhood that is underserved, that argument would more than likely lead to a successful appeal.  Not all times when a company says their panel is closed means it is impossible to participate.  It may take a little longer, but we will always persevere on your behalf.

Q. What payment methods do you accept?

A. We accept Visa, MasterCard, American Express and checks.