Frequently Asked Questions
What do I need to be credentialed?
To be credentialed you need to be fully licensed in the state you practice; have a complete and up-to-date CAQH, an NPI, a minimum $1 mil/$3 mil liability insurance and a place of service (either your own or an employer)
What is CAQH?
The CAQH is a national professional database for medical and behavioral professionals, sort of like an online compilation of your professional requirements. It must be updated and re-attested quarterly. The Insurance Companies use this for determining credentialing and require that all licensed providers keep their profile up to date with resume, licenses, liability insurance and professional certifications.
Can Registered Interns / limited-license providers be credentialed with insurance companies?
In the state of FL, neither Registered Intern nor Provisionally licensed providers can be credentialed. Other states allow for limited credentialing in some areas. If you aren’t sure how your state operates, we will find out for you before we waste time or your money!
But I’m not fully licensed and I take insurance at my current practice
In most states, non-license Masters Level providers may see Medicaid clients under the supervision of a credentialed, licensed provider, but they are not actually credentialed themselves. When the claims are forwarded to billing, it is the Licensed Provider’s name, NPI and Medicaid number that are submitted. Few commercial plans allow a non-licensed provider to provide services.
Why does the process take so long?
We require primary source verification of all your activities since medical school or applicable education. We are dependent upon responses to our queries regarding training, experience, affiliation, professional reference, licensure and any malpractice information, etc. Therefore it is imperative your application be filled out in detail with regard to dates (month and year), addresses, and contact information.
Do I get to choose the panels I want ?
Yes. When you sign up for credentialing with us, you get to choose exactly which panels you want, and don’t want, to be credentialed with.
What if the insurance panel I want to be credentialed with is closed?
Finding a closed panel can be frustrating. However, sometimes when panels say they are closed, they are still accepting providers, but on a limited basis. In the case of a panel saying that they are closed, we can still submit an appeal to the insurance company on your behalf. During an appeal, we will try to connect with the insurance company representative assigned to your area. We will then stress important parts of your qualifications and clinical practice. For instance, perhaps you have a specialty that the insurance company desires, or you are practicing in a neighborhood that is underserved. We do have success with many of our appeals. However, if a company is saying that their panel is closed, it might not be possible to get on the panel at that time.
Am I guaranteed to get on the panels I choose?
No. Unfortunately, there are no guarantees of contracts, although “others” may offer them. CCCFL only guarantees that we will PUT FORTH 110% effort and do EVERYTHING possible to get you on those panels.