Buried in
credentialing
paperwork?

CREDENTIALING SOLUTIONS

Let us manage your credentialing process.

Are you being buried in a mountain of paperwork?

Do you look forward to spending 10-20 hours of your time and waiting 30-120 days before you finalize your desired insurance participation? We doubt it.

Our clients let us manage their credentialing needs.

Most people don’t enjoy doing paperwork - which is why we complete over 3,500 applications each year. So, whether you want to join or leave plans, update directory information or remove your listings from previous employers, Five Lakes can manage all of it. We’re very good at it - and we actually like it.

We make it easy. And fast.

Simply choose from a list of PPO plans or let our PPO Insurance Analysis drive your insurance participation decisions. Five Lakes provides full-service credentialing for PPO plans across the country. You’ll have plenty of choices and life will be easier.

Why choose Five Lakes for your credentialing?

1
The most comprehensive carrier analysis on the market.

We’ll help determine the very best plans based on YOUR practice and YOUR goals.

2
We’ll do all the heavy lifting. And do it right.

We’ll complete your applications with accuracy and attention to every detail.

3
You can count on us. From start to finish.

We submit your applications, track the status and handle any issues during the process.

A few facts about credentialing.

Credentialing is the process that reviews a provider’s qualifications and credentials including their education, training, residency, licenses, specialty certificates, work and malpractice history.

Credentialing must be completed in order to participate with insurance carriers for most network types. Providers are credentialed upon first time enrollment for participation and then regularly afterwards, around every 3 years, depending on the state. Credentialing must abide by the standards set forth by regulatory and accreditation organizations such as the National Committee for Quality Assurance (NCQA).

Once a provider enrolls with an insurance carrier for the very first time, that initial credentialing is valid for approximately 2-3 years, depending on the carrier and the state in which you practice.

Providers become due for re-credentialing once this 2-3 year time period has lapsed and they are required to resubmit documents to become “re-credentialed”. This is the process in which the insurance carriers re-verify licenses, malpractice history and other provider information.

When should I begin the credentialing process?
Existing practices adding a new associate:As soon as possible, preferably at least 90 days from the provider’s anticipated start date at the practice.

Acquisition/Transition Practice:As soon as the sale of the practice closes, and you have an executed bill of sale in hand.

Start-Up:Preferably at least 90-180 days before opening.
Why does the credentialing process take so long?
Credentialing is a lengthy process. Insurance carriers must review the applications submitted and primary source verify that all education, licenses, work history and provider background checks are complete and accurate before a provider can be made effective. Each carrier has their own internal processes for how these tasks are completed. In addition, if a provider has any licensing board actions or malpractice history, they must go through the insurance carriers credentialing committee for extra review and approval.
I have multiple locations; do I have to be in-network at every location?
No. Providers are not required to participate at every location that they practice at, however, some carriers will follow you to other locations based on your NPI.

Credentialing is the process that reviews a provider’s qualifications and credentials including their education, training, residency, licenses, specialty certificates, work and malpractice history.

Credentialing must be completed in order to participate with insurance carriers for most network types. Providers are credentialed upon first time enrollment for participation and then regularly afterwards, around every 3 years, depending on the state. Credentialing must abide by the standards set forth by regulatory and accreditation organizations such as the National Committee for Quality Assurance (NCQA).

Once a provider enrolls with an insurance carrier for the very first time, that initial credentialing is valid for approximately 2-3 years, depending on the carrier and the state in which you practice.

Providers become due for re-credentialing once this 2-3 year time period has lapsed and they are required to resubmit documents to become “re-credentialed”. This is the process in which the insurance carriers re-verify licenses, malpractice history and other provider information.

When should I begin the credentialing process?
Existing practices adding a new associate:As soon as possible, preferably at least 90 days from the provider’s anticipated start date at the practice.

Acquisition/Transition Practice:As soon as the sale of the practice closes, and you have an executed bill of sale in hand.

Start-Up:Preferably at least 90-180 days before opening.
Why does the credentialing process take so long?
Credentialing is a lengthy process. Insurance carriers must review the applications submitted and primary source verify that all education, licenses, work history and provider background checks are complete and accurate before a provider can be made effective. Each carrier has their own internal processes for how these tasks are completed. In addition, if a provider has any licensing board actions or malpractice history, they must go through the insurance carriers credentialing committee for extra review and approval.
I have multiple locations; do I have to be in-network at every location?
No. Providers are not required to participate at every location that they practice at, however, some carriers will follow you to other locations based on your NPI.

Ready to learn more?

Let us help you get better insights into your marketplace so you can make more informed decisions.

Call us at 877.955.2537 or click the button below.

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