[ICS] Insurance Credentialing - Process

Once the Credentialing Onboarding Form is submitted, you will be sent an invoice depending on number of insurances you choose. Here is the breakdown of fees for insurance credentialing services;

• Setup Fee (Non-RCM Clients Only)

                   $249

• Charge Per Insurance 

                   $99 x No. Of Payers

Once the invoice is cleared, you will be asked to submit documentation related to your Insurance Credentialing Application.

Our team will apply to desired insurance panels (Medicare, Medicaid, BCBS, Aetna, Cigna, UnitedHealthcare, etc.).
 

These applications can be submitted online via payer portals or paper forms along with attaching all required supporting documents.

The insurance company verifies provider’s credentials through:

• State medical boards
• Educational institutions
• Licensing agencies
• NPDB (National Practitioner Data Bank) 
• OIG/SAM exclusion lists

Payer’s credentialing committee reviews the provider’s application.

Checks compliance with payer and state requirements & may request additional documents or clarifications.

 Once approved, payer sends a participation contract.

Contract specifies:
 

• Reimbursement rates
• Billing rules
• Termination clauses
• Effective date

Provider is now added to the payer’s network and all plans covered under that network.
 

Effective date is usually when provider can start billing as “in-network.” some payers also allow retroactive billing back to application submission date.

Payer Timelines

• Medicare: 25-30 Days
• Medicaid: Often 90–150 days
• Commercial payers (Aetna, UHC, Cigna, BCBS, etc.): Typically 60–90 days

Breakdown By Process

• Setup & Information + documents gathering: 7 Days
• Application Submission: 3-5 Days
• Followup: Every 3-5 Days