Credentialing is not a one-time task it’s an ongoing responsibility. Healthcare specialists must maintain compliance with ever-evolving payer and facility requirements to ensure uninterrupted patient care and timely reimbursement. Falling out of compliance can result in claim denials, disciplinary action, or even removal from provider networks.
At Eyecare Billing Associates, we help specialists stay credentialed, compliant, and confident. Here are key credentialing compliance tips every provider should keep in mind.
1. Stay Ahead of Recredentialing Deadlines
Most payers require recredentialing every 2–3 years. Failing to complete this process on time can result in termination from insurance networks. Track all recredentialing deadlines and start the process at least 90–120 days in advance to allow time for verification and approvals.
Pro Tip: Set calendar reminders and keep a digital record of all important dates.
2. Keep Your CAQH Profile Up to Date
Your CAQH profile is the central hub for many credentialing applications. If it’s outdated or unverified, payers may reject or delay your submission. Log in every 120 days to re-attest your information, even if nothing has changed.
3. Update Licenses and Certifications Promptly
Whenever your medical license, DEA certificate, malpractice insurance, or board certification is renewed or updated, notify all payers and facilities. Failure to do so could put your credentialing status in jeopardy.
Don’t wait until recredentialing update your records in real-time.
4. Watch for Gaps in Work History
Credentialing committees pay close attention to gaps in employment or training. Be ready to explain any periods of time longer than 30 days where you were not actively practicing or in education.
Provide written explanations upfront to avoid delays.
5. Respond Quickly to Payer Requests
Insurers often request additional information or clarification during credentialing. Delayed responses can halt the process. Check your email regularly and work with a credentialing partner to keep communication organized.
6. Work With a Credentialing Specialist
Credentialing requirements vary by payer, specialty, and state. Working with an experienced credentialing company, like Eyecare Billing Associates, ensures nothing slips through the cracks.
Final Thoughts
Credentialing compliance isn’t just about getting approved; it’s about staying approved. Let Eyecare Billing Associates handle the paperwork, deadlines, and follow-ups so you can stay focused on patient care.
Need credentialing help? Reach out to us today for expert support.