Medical Credentialing Independently or Under a Group: Being Credentialed FAQ

Q: Hope you're doing well.  I have a quick question about how the credentialing has been performed on behalf of COMPANY's Therapists.  It dawned on me that there is the possibility that the credentialing company has been credentialing Mary and Joseph as individual practitioners only rather than first credentialing COMPANY as a group with the carrier and thereafter credentialing Joseph and Mary as clinicians under the group paneling.  At your earliest convenience, can you please confirm that Thriveworks has been seeking to obtain COMPANY group credentialing for those carriers with which the agency is not already paneled?


There happen to be some carriers on the target list with which COMPANY is already paneled, but there are some that we have yet to approach.  So, I'm in need of some clarification on how this matter has been handled.


A: Hi George,

That's a good question, and I have an answer for you.

Joseph and Mary and credentialed both independently, and under your group practice. Meaning, they are credentialed to practice at your practice, and to bill under your practice's tax-id number. They are not right now authorized to practice anywhere else, but might have a foot in the door with some companies if they wished to add or change the practice (tax-id number) they were billing under. 

Various insurance companies handle the issue of group practice credentialing differently. Some have us complete an application for the group, and send that application in first, before we can add providers to the group (or send in 3 applications at the same time: one for Joseph, one for Mary, and one for the group). Other companies add the group to their system when we credential the practice's first provider. For example, we send in Mary's application with the group information and tax ID number--and both Mary and the group get put into the insurance company's system. 

 

I appreciate your concern about Mary and Joseph being credentialed "wrong." That is, that they are independently credentialed in lieu of the company getting credentialed and them being under them (protecting the company!). I had similar concerns when I first began credentialing providers for my own practice 5 years ago. They are being credentialed not only the right way, but really the only way that credentialing works for group practices. 

I hope this helps!

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