As you can imagine the re-credential process varies by payers. CMS/Medicare call it revalidation and as long as you don't let it expire your participation continues, with the recredentialing the earliest is 30 days. For Private insurance, it is a minimum of 60-90 days, but I have seen it 90-120 days or more. If a provider is currently credentialed and is in the process of recredentialing as long as the participation status has not changed, then the provider can continue billing for services while waiting on the recredentialing. If you are asking when a new practitioner bill for services, it is generally recommended to hold billing from the date the Insurance has said they received the application and started considering participation. Make sure you get it in writing that the start date will be retroactive to the date they started processing the participation status. It is recommended to request them to provide the date they will consider and only then should the provider see patients in that insurance plan.
I’ll chime in on the DME credentialing process. For those who west of the Mississippi it’s a much easier process as they are the old NSC and fully staffed
East of the Mississippi it’s a nightmare.
The issue is that Novitas is a newcomer and under budgeted and are seriously backed up. Any error derailing the application process results in your application being pushed towards the back of the line. There are significant updates to the application and I don’t recommend providers completing these very complicated applications on their own l. That includes hiring billers who have minimal if any experience in enrollment or compliance issues.
I have heard of 6 month or more delays with no guarantee of successful completion .
Several clients of mine who’ve tried to do these applications on their own are now hundreds of thousands of $$$ due to these delays or revocations.
As you can imagine the re-credential process varies by payers. CMS/Medicare call it revalidation and as long as you don't let it expire your participation continues, with the recredentialing the earliest is 30 days. For Private insurance, it is a minimum of 60-90 days, but I have seen it 90-120 days or more. If a provider is currently credentialed and is in the process of recredentialing as long as the participation status has not changed, then the provider can continue billing for services while waiting on the recredentialing. If you are asking when a new practitioner bill for services, it is generally recommended to hold billing from the date the Insurance has said they received the application and started considering participation. Make sure you get it in writing that the start date will be retroactive to the date they started processing the participation status. It is recommended to request them to provide the date they will consider and only then should the provider see patients in that insurance plan.