The most laborious and lengthy process in setting up a practice is the credentialing process. While the top 10 medical insurance carriers in the area can be obtained from the medical staff office of the local hospitals, it may not be in your benefit to contract with these entities depending on reimbursement. It is possible to submit your top codes (based on volume) to the insurers provider relations and they will give you their fees paid for each. Most insurers will not negotiate codes with individual providers, so you must decide to take it or leave it. Other providers will print out their main fees in your area of specialty, while others may give you a weblink to view the current fee payments to physicians. The process of credentialing involves application completion, submission of documents, calling the companies or checking status of the application on-line, obtaining the letter of credentialing acceptance, and notation of effective start date (usually 30-90 days after credentialing acceptance). Usually insurers will not approve claims submitted before the effective date unless the carrier is Medicare and Medicaid. In those cases, it is better to hold the claims until status as a participating provider is verified, then the claims may be submitted up to one year after the service was provided. Once caveat is that Medicaid in some states will retroactively approve Medicaid coverage up to one year in the past. If there are self pay patients that then receive Medicaid coverage, it is possible the provider will owe the patient a refund for monies paid. This is of course only true if the patient retained all the billing and paperwork for each office visit and submits to Medicaid for payment to be made to the provider, and then requests a refund from the provider. There are basically two ways to be credentialed: 1. insurance company sponsored credentialing services such as CAQH or PHCS 2. individual insurance credentialling. applications. The credentialing services are free to the physician and the forms for such may be filled out on-line. However the time to fill out a form online is lengthy: 3-4 hours for PCHS. Current CAQH insurance plans and companies may be viewed here. The CAQH service includes credentialing for Aetna, Anthem, Cigna, several Blue Cross plans, etc. In order to register on-line with CAQH you will need the following information: Basic Personal Information Education and Training Medical /Professional school Graduate school Internships and residencies Fellowships and preceptorships Teaching appointments Specialties and Board Certification Practice Location Information Practice name and type Address and contact information Billing, office manager and credentialing contact Services, certifications, limitations and hours of operation Partners and covering colleagues Hospital Affiliation Information Malpractice Insurance Information Work History and References Disclosure and Malpractice History CAQH credentialing requires approximately 2-3 hours on-line. To use the CAQH system for the first time, you must call 888.599.1771 and ask for a provider ID number (will be assigned to you). After receiving this number, then you may create an account here (read the info and click next), and continue with the on-line form completion. Current PHCS insurance plans inexplicably cannot be viewed online. Instead, the physician must engage in an arcane inefficient process in which individual insurance companies must be contacted by the physician, then the physician is told by the insurers if they use the PHCS service. For these insurers, it is mandatory to use the PHCS service, therefore it is absurd that the insurer cannot be viewed first. Alternatively, one may simply apply through PHCS for all area insurers. The PHCS provider forms online or snail mail may be found here. Both CAQH and PHCS provider information can be changed at anytime on-line, which is an excellent benefit for any address changes. It also makes it possible to list one practice address (proposed) and after you are approved through the credentialing process, the address may be altered. It is not necessary to participate in all plans offered by the above services if their fee schedules are insufficient. Most HMOs require separate credentialing, however it may be prudent to avoid HMOs when possible due to very poor reimbursement. Although HMOs are supposed to give equal access to their plans after a Supreme Court decision within the past few years, some still will not, prefering to insulate those providers already on the plan from any competition. Other individual health insurers not using the above services can usually be contacted through provider relations at the main telephone number for each insurer. Often, the medical staff office of a local hospital will have their direct telephone number. Medicare provider credentialing now is available through an on-line form but in order to use such form, a separate "formatta filler" program must be installed on your computer. Click here to install the formatta filler program. After downloading that program, click here to download the 855I form to your computer which can then be completed on your computer, printed, signed, and then mailed to the medicare carrier. Alternatively, a pdf version of the form may be found here which can be printed, filled out by hand, and then mailed to the appropriate Medicare carrier (click here to find the carrier in your area). Other Medicare forms which you will need to complete are available in pdf format, should be printed, filled out, and sent to your Medicare carrier. These forms include (click on each for the link) Participating Provider Agreement, Electronic Funds Transfer Agreement (direct deposit from Medicare into your business account- form CMS-588), and the Electronic Data Information agreement (provides confidentiality for electronic claims submission to Medicare). The Medicare provider enrollment website is located here. Finally, for a change of address, you need form 855R which may be obtained from the carrier. It is possible in some states to enroll in Medicaid but not accept or limit Medicaid patients to your practice. Because of extremely low reimbursement rates, some physicians do not accept Medicaid patients. Due to increased substance abuse and diversion in this population, some physicians do not accept Medicaid. If you wish to enroll in Medicaid, you may call the provider relations numbers or perform a search under your states name and "Medicaid Provider Enrollment".