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FREQUENTLY ASKED QUESTIONS

We’ve created this Frequently Asked Questions (FAQ) document to help new and established licensed health care professionals understand the process of becoming a solo or group practitioner.

  • What is credentialing?
    The credentialing process is the process of collecting and verifying each health care professional’s qualifications.
  • Is Credentialing important?
    Yes! Credentialing allows the designated administrative staff to assess qualifications, relevant training, licensure, liability insurances, professional references, internships/resiodencies/fellowships, certification and/or registration to practice within their specified specialty. Insurances have multiple steps they utilize to make sure their network providers have the credentials required to care for their members.
  • What do I need to start the credentialing process?
    Yes! Users can add video from YouTube or Vimeo with ease: Training and Education Certifications and Licenses NPI/Group NPI (If applicable) Cirriculum Vitae (Gaps > 3 months must be explained) Malpractice History Professional Insurance Liability If applicable- DEA and CDS Certificate If applicable- Medicaid and Medicare Provider ID# If applicable- Admitting Privileges Completed W9 Completed CAQH (with no errors)
  • What is a CAQH and is it relevant to payor enrollment?
    CAQH is Council for Affordable Quality Healthcare. It is the central home to all insurance payors except Medicaid and Medicare. Yes, it is relevant to payor enrollment because healthcare organizations access data to help credential a provider seeking to become an in-network provider. It also
  • How long does it take to create a CAQH?
    The length of time it takes to complete a CAQH all depends on if the provider has all the required documents and important dates to complete each section. The CAQH profile must be in good standing with no errors. Insurance companies will reject an application with a expired or incomplete CAQH account.
  • Do you have to accept every insurance?
    No. You are able to select the insurance panel for the population you want to serve.
  • Do I have to accept Medicaid/Medicare line of buisness under each payor?
    No. However, if you choose to service individuals who are under the Medicaid/Medicare line of business for a specific commercial plan, you must be enrolled as a FFS of Medicaid/Medicare Provider.
  • How long does the credentialing process take?
    The credentialing can between 90-120 days. For some insurances it can take a little longer given the accessiblity of information, errors, or inaccuracy of information. The longer it takes to collect documents from the providers, the longer the enrollment process. Given the pandemic, there have been significant delays in communication and processing.
  • Does Preferred Choice Credentialing have experienced credentialing providers in my specialty?
    If you are eligible to be credentialed, we can get you credentialed!
  • For every insurance panel applied for I will be approved to join their network?
    No. Sometimes there is a density in the area or specialty and the panel will be closed. We often inquire if there is a specific language or certification. Advance trainings and fluency in multiple languages can prove to be an asset to specific insurances.
  • What is NPPES?
    NPPES is the National Plan and Provider and Enumeration System. This is the system that generates your NPI. Information here must be updated for verification and validation purposes. For continuity of care you should list a direct address to promote interoperability and Health Information Exchange (HIE).
  • Do you provide medical billing?
    Yes. We provide medical billing utilizing the EHR platform that you are signed up with at the time our contractual agreement. We have vendor partnership with Kareo EHR and Claims MD
  • Do you need to be recredentialed once in network?
    Yes. Recredentialing can be required every 3 to 5 years depending on the payor.
  • Is credentialing different from contracting?
    Yes. Credentialing is all about verifiying your credentials and contracting is about the agreement with you and authorized representative approving you a participating provider.
  • Can a provider have more than one Individual NPI
    No.
  • Can you enroll in every panel in every state regardless of your specialty?
    No.
  • Do I have to be board certified in my specialty to qualify?
    Board Certification looks good on paper but it is not required.
  • How do you I collect co-pays if I am telehealth provider?
    It is recommended that you accept payments via Zelle and Paypal.
  • Does Preferred Choice Credentialing have a credentialing platform?
    Yes. We utilize Intivia Health Medical Credentialing software to manage all information provided by the providers.
  • Can I bill for my patients before I am in contract?
    No. You must be in contract prior to submitting a claims.
  • How long does it take a claim to be processed and paid?
    It can take up to 30 days. It can take more than 30 days if the claims is not completed accurately and efficientlyh.
  • How long does it take to build a website?
    It can take up to 30 days. This all depend on revisioins requested, information submitted and color schematic.
  • Do I need Malpractice to become a Medicare or Medicaid FFS provider prior to enrollment?
    No. You are not required to have malpractice insurance in place prior to submitting an individual enrollment
  • If I acquire a license in another state will my participation transfer over for plans that are available nationwide?
    No. Medicare applications are the same nationwide but may have a different Medicare Contractor. Medicaid enrollment process is not the same for every state. Some states can take 15 days to process a FFS (Fee For Service) application or up to 120 days. For nationwide commercial plans like Aetna, Cigna, United HealthCare, etc, you will need to update demographics and provide supportive documentation. It is very important to know that you can not just be simply practice telehealth across state lines without having the appropriate credentials and meeting the licensing requirements. Some will require that you have a place of service for those patients that want face to face service.
  • Can I list multiple specialties on my CAQH?
    You can only have one primary specialty within the CAQH that will recognized as your primary. So if you the insurance application has a direct interface with the CAQH where it pulls in the information automatically. The primary specialty listed is the one that will be recognized.
  • I tried to activate my Availity account and it said that my responses were inaccurate, but they are accurate. What am I doing wrong?
    You are not doing anything wrong. Availity validates your information based on what is listed on your NPI registry. If your information has not been updated in years it may pose an issue when attempting to create an Availity account.
  • What are your fees for Credentialing?
    Our fees for Credentialing range from $175.00 to $200.00 The minimum fee entails credentialing and no follow up. All information is turned over to you once the application process is completed The maximum fee entails credentialing with follow up . We stay the course until you have a status of "Par" with the insurance panel. If you are reattesting or revalidating the fee is $150.00. We stay the course until we know your status is in good standing.
  • What are your fees for Medical Billing?
    Although we have a standard price for medical billing, we provide that information at the time of consultation. Feel free to contact us directly via email at preferredchoicecredentialing@gmail.com or zmabillingllc@gmail.com Send an inquiry online at preferredchoicecredentialing.com or zmabilling.com Call us at (347) 569-5995
  • Can we contact one of your existent clients about the services you offered them and your current relationship?
    Absolutely. We pride ourselves on providing reliable services and remain transparent throughout the whole process We work with solo, midsize, and large group practices. As we have a 95% referral rate, it was determined that one of our key performance indicators as to why providers remain with us or return for additional services is because we educate them in every aspect of credentialing and medical billing so they can make informed decisions that aligns with their practices goals. Please feel free to submit an inquiry for an existent clients information and we will send the information to you. One thing you can expect from our clients is a truthful response and real life examples of how we have or currently work together.
  • Do we credential or provide medical billing services to clients outside of the state of NY?
    Yes, we have clients in the following states and growing: South Carolina, Georgia, Florida, New York, New Jersey, California, Texas
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