Credentialing New Physicians- It takes planning and perfect timing

It is always a good sign when your practice recruits a new physician fresh from medical school. It brings attention to your practice, and can help you build a reputation of being a forward-thinking practice that offers the newest and best patient care practices. Don’t let the credentialing process undermine those immediate benefits. Credentialing for a new physician requires advance planning and a fairly long lead time. As soon as you know the new physician will be joining your practice, you need to start the credentialing process. You want to make sure that as soon as s/he arrives at your door ready to begin seeing patients, they are also set up to bill properly.


If you have to wait for your new physician to receive practice credentials, you cannot bill for his/her patient services in the meantime. Billing for your non-credentialed physician will result in denied claims to government health programs and either denials or out-of-network claims by commercial plans. Claims that are improperly paid during this time period can lead to audit problems, such as demand for reimbursement repayment, and a possible investigation into your billing practices. Most third party payers will not retroactively reimburse your practice for the new physician’s patient services, so that isn’t an option either. If a patient receives care from a non-credentialed physician, the patient may have to self- pay. As you can see, it’s important to get the new credentialing done right and on time, the first time!

Credentialing is a detailed and sometimes laborious process. That’s what we do. We take care of the credentialing process. Whether you have a new physician, a transferring physician or need re-credentialing, call us. We can save you time, money, and frustration! In our next blog we will give you tips and insights on how to credential a new physician the right way- the first time.